
.■^a^.^.SV^, ^^,j^^ ■^r - .^.,> "^ -.,>B^^ '^^ ^^A.^^m..^^^,^^^^^^^ 



L_ 



ANTHROPOMETRY 



AND 



PHYSICAL EXAMINATION 



A BOOK 



FOR PRACTICAL USE -IN CONNECTION WITH GYMNASTIC 
WORK AND PHYSICAL EDUCATION. 




JAY W. SEAVER, M.D., 



Instructor in Gymnastics and Lecturer on Practical Hygiene in Yale University. 
Lecturer on Anatomy, Physiology and Anthropometry in the Chautauqua 
School of Physical Education. Ex-Secretary of the American Asso- 
ciation for the Advancement of Physical Education. Mem- 
. S ber of the Connecticut State Medical Society, etc. 



NKW HAVEN, CONN. 
1890 



"^:;::a 






Copyright, i8go, by Jay W. Seaver. 



PRESS OF TUTTLE, MOREHOUSE & TAYLOR, NEW HAVEN, CONN. 






CONTENTS. 



CHAPTER I. 

THE USES OF ANTHROPOMETRY AND THE EXAMINER HIMSELF. 

The need of physical training for the young. — The inductive 
method. — The scientific basis of gymnastic work. — Anthro- 
pometry furnishes a standard of physical excellence and 
shows actual changes in condition. — The therapeutic value 
of gymnastics. — The standard for the examiner and per- 
sonal advice. 9-22 



CHAPTER II. 

APPARATUS TO BE USED AND RECORDS TO BE KEPT. 

A list of instruments with illustrations. — Description of new 
apparatus and simple methods of taking measurements 
and tests. 23-38 



CHAPTER III. 

WHAT TO MEASURE AND HOW TO MEASURE. 

The technique of measurement. — The rules and list of items re- 
commended by the Amer. Assoc, for the Adv. of Phys. 
Ed. — Criticisms and 'suggestions. 39-52 



CHAPTER IV. 

PERSONAL HISTORY AND EXAMINATION OF SPECIAL SENSES. 

The private record. — Family histor3^ — Exercise. — Results. — Ex- 
amination of the eyes, ears, etc 53-63 



6 Contents. 

CHAPTER V. 

EXAMINATION BY INSPECTION. 

Front, side and rear aspects. — Points that the eye must discover. 

— Table. 64-76 

CHAPTER VI. 

EXAMINATION BY PALPATION. 

Methods and results. — Normal movements. — Abnormal condi- 
tions. — Tumors 77-82 

CHAPTER Vn. 

EXAMINATION BY AUSCULTATION AND PERCUSSION. 

Methods. — Areas. — Normal sounds. — Abnormal sounds. . . 83-98 
CHAPTER Vni. 

THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 

Discussion of the anatomy of heart sounds, normal and abnor- 
mal. — Tables. 98-106 

CHAPTER IX. 

THE PRESCRIPTION OF EXERCISE. 

Methods of getting an idea of a perfect form. — Removal of causes 
of debility and deformity. — Respiration. — Nervous cases. — 
Forms of prescription 107-121 

CHAPTER X. 

GRAPHIC ANTHROPOMETRY. 

Tables, charts, etc 122-128 



PREFACE. 

The only reason for the appearance of this little book is 
the desire to meet to some extent the demand that exists 
for instruction in the great field of physical education, and 
thus to put a work of the greatest importance on a higher 
plane. The organization of schools in this country, for 
the training of teachers to take charge of the physical 
education of the people, is a recent development. The 
demand for competent instructors in this department of 
work has far outstripped the supply and"^ therefore what- 
ever will prove a help to instruction is to be welcomed, 
however meagre and unpretentious it may be. 

The only excuse that can be urged for the imperfect and 
poorly-arranged character of the work is that it has been 
done in moments between professional cares and college 
duties. 

I wish to express my thanks to Drs. Hitchcock of 
Amherst, Kellogg, Hitchcock of Cornell, Anderson, Sar- 
gent, Savage, and others, for the courtesy they have shown 
me in permitting the use of material that has been pre- 
pared by them at great expense of time and labor. 

Jay W. Seaver. 
New Haven, Conn., 
i8qo. 



CHAPTER I. 

THE USES OF ANTHROPOMETRY AND THE EXAMINER HIMSELF. 

Educational systems are rapidly being broadened by the 
new standards that have been set by the advance of science 
or the demands of social organization. At one stage in the 
history of civilization the great man was the one who over- 
powered all others by physical strength. Such a man easily 
gathered around him a retinue of weaker followers, either 
as subdued competitors or weak dependants who must 
seek some strong person for protection. This condition of 
affairs evolved great physical hardihood and endurance but 
the limitations of development were reached under ignor- 
ance of physiological laws and the waste caused by impru- 
dence. Later on the mental activity of the genius gave him 
a new weapon in competition, and a new force was added 
to the growth of civilization. This new element was in one 
respect at least entirely different from the old dominating 
force, in that it could be shared with others without loss to 
the original possessor. Any new invention or craft or idea 
could be taught to others while mere physical strength 
could only be directly transmitted through hereditary chan- 
nels. 

It is safe to say that for the last three-quarters of a cen- 
tury the history of civilization must record rapid physical 
deterioration among the families who have been most act- 
ive in evolving new ideas for the refinement of life and the 
amelioration of its hardships. Close application in each 
department of mental activity and a consequent neglect of 
the physical basis for life, which depends on muscular ac- 
tivity, have drawn heavily on the surplus vitality stored up 
by many generations of healthy and frugal ancestors ; and 



10 The Uses of Anthropometry 

in too many cases we find prominent names drop altogether 
from town records and public lists. France has already- 
reached a point in her history as a people when the natural 
physical increment barely meets the yearly loss of her pop- 
ulation, and similar tendencies everywhere are calling the 
attention of thinking people to the startling limitations that 
stare civilization in the face. 

Medical science has, by the discovery and promulgation 
of physiological laws and hygienic principles, done much 
to avert the disaster by eliminating many of the deleterious 
influences that act with special potency against the weak- 
ened and delicate. The beneficent influence on humanity 
has been partly overcome, however, by the rearing of weak- 
lings whose career would have been short under less intel- 
ligent care ; but, neglecting this part of the race that is 
doomed to natural extinction, we find that medical science 
has done nothing directly to avert the calamity that has 
menaced civilization from extreme specialization. 

It is but natural that the evil effects of excessive mental 
stimulation without a suitable physical basis for the sup- 
port and expression of nervous phenomena should have 
first been noticed by educators and those with training in 
some scientific pursuit. Ling of Sweden gave his life to 
the study of the needs of the body, and established a system 
of exercises that would do for the body what the routine of 
study would do for the mind. His exercises were graded 
from light, free movements up to complicated work with 
apparatus, thus forming a complete system of physical 
education that has been prescribed by law in all the schools 
of Sweden. What Ling did for Sweden Jahn did for Ger- 
many, establishing a system of societies where the practice 
of bodily exercises was the principal feature of .the oraniza- 
tion, the improvement in physical stamina and the patri- 
otic zeal that resulted was sufficient to drive Napoleon out 
in 1810, and since that date there have been efforts to make 
physical training universal in the German Empire, and with 
satisfactory results. 



and the Examiner Himself. ii 

In France the establishment of the Republic was the time 
when public attention was first aroused to the needs of a 
physical education that should proceed hand in hand with 
the school work of the children ; but factional dissension 
and the reorganization of a government have taken so much 
of the interest of the people that French educational mat- 
ters have not kept pace with the progress in other countries. 

In England there has been no great demand for physical 
training, for the active outdoor sports that engage old and 
young have taken the place of the rural occupations and 
hunting that the early Kelt and Saxon followed — except 
in the larger cities, and there competent observers like 
Francis Galton, and Dr. Roth and Mrs. Westlake, of the 
London School Board, insist that some form of physical 
education must be adopted. 

In America the development of a matchless territory by 
a population that is heterogeneous, representing all condi- 
tions of life placed on a common plane, has given free 
scope to competition. The large return for labor has in- 
cited to the fullest expenditure of effort. Wealth has 
grown enormously. The unnatural distribution of indus- 
tries, caused by legislative interference with supply, has 
caused an unnatural and unfortunate location of the peo- 
ple. Twenty years have seen our urban population more 
than double, while in the older parts of the country the rural 
population barely holds its own. The rapid development 
of complicated systems of business in the scramble for 
sudden wealth has required the outlay of intense energy, 
and this demand on the vital force of the people has come 
before they were fully acclimated to the new conditions of 
the country. The result has been an excess of nervous 
diseases and premature breaking down of our people. The 
time when a large majority of our people worked out in 
the open air has passed, and now the counting-room and 
the factory shut in the majority during the hours of sun- 
light. This strain on vitality is beginning to be felt, and 
a remedy must be sought at once in all the large cities of 



12 The Uses of Anthropometry 

the country. In some way, artificial though it be, some 
increase of vitality must be found. The sturdy strength of 
our fathers, that was gained by an active life in the open 
air, cutting forests, cultivating land, traveling on horse- 
back, in the service of society, sailing ships, and kindred 
pursuits, must now be gained by exercise obtained in an- 
other way. 

In response to this feeling of a need of improving the 
physical side of our lives there has been a widespread move- 
ment in the cities of our country toward the formation of 
clubs for exercise. In the larger cities these clubs have 
provided large and well equipped gymnasiums for the use 
of members, and in the smaller towns the Young Men's 
Christian Associations have been the pioneers in this work 
of improving the physical status of the young. But in each 
town where a gymnasium was provided by some organiza- 
tion there has been an appreciation of imperfect, if not of 
disastrous, results from the lack of intelligent direction and 
competent instruction. 

A gymnasium has been compared, by some writer, to a 
drug store — full of good things if intelligently used, but 
full of evils if taken indiscriminately. The number of men 
who were fitted to take charge of a gymnasium even ten 
years ago was exceedingly limited, and these few were 
mostly Germans who understood German methods and 
German needs better than they did American. 

The question, then, has been and is. What use of the 
gymnasium will be best for the individual case ? Does he 
need a large or small dose ? 

The physician in treating his patient must recognize 
every sign and symptom, and then, with whatever histori- 
cal data he can discover to aid his judgment, he prescribes 
treatment. It must be so in our management of cases in 
the gymnasium. We must learn what is the physical pe- 
culiarity and condition of each pupil. A general system of 
light exercises can be carried out successfully if the instruc- 
tor is conservative and careful, without a physical examin- 



and the Examiner Himself. ij 

ation as the first step ; but, to do the best with the facilities, 
there must be intelligent discrimination of work, as so few 
persons have the same physical requirements even if healthy. 
The director, then, must know what material he would 
mould and develop, and he must again examine to see if 
the results of his treatment are satisfactory or such as he 
expected, and hence the need of a record of the past condi- 
tion. A statement of a size or strength in black figures is 
worth a dozen " opinions." For the imperfect the exam- 
ination will cause a cautionary signal to " go slowly " or 
" stop " to be hung out before disaster comes and discredit 
is thrown on the work, or a new method is prescribed that 
affords relief. 

Science has taught us that in living organisms functional 
activity must be kept up, or there will be no development. 
A part or group of organs unused will atrophy and become 
useless. Heredity soon stamps a deformity, that has been 
developed in two or three generations, as a type and suc- 
ceeding generations that do not possess that peculiarity 
are looked upon almost as new varieties. This is especially 
true of physical defects that impair the vitality of the pa- 
rents. Notice the stress laid upon this law by life insur- 
ance companies where business interests have no bias from 
sentiment. The excellent health of the applicant is not 
enough, if there be a record going back two or three gen- 
erations of degenerative diseases that have proved fatal, or 
if the constitutional vigor has been so weak as to let the 
life go out at about forty-five or fifty years of age from any 
immediate cause. 

The first lesson that we must learn from this truth is, that 
health can not exist if vital organs are seriously undevel- 
oped. 

Health is the condition of harmonious adjustment of 
all the functional activities. For instance ; a normal pulse 
rate is from 72 to 76 beats per minute, under ordinary con- 
ditions of rest, but a pulse-rate of 72 after a half-mile run 
might be considered abnormal and the ground for solici- 



i/f. The Uses of Anthropometry 

tude, — for health would demand an increased activity of the 
heart muscle to supply increased blood currents to the ac- 
tive muscles, that waste products may be eliminated and 
restorative elements supplied. But further : An adjust- 
ment of the pulse rate is not all that is to be required in 
the case cited; for there must be a corresponding increase 
of respiration for elimination and oxidation. And so the 
perfect activity of any organ — even the brain — may be 
shown to be dependent on the healthy activity of other or- 
gans, while the converse may be stated as a physiological 
truth, viz : that the imperfect action of any organ impairs 
the function of all others to some extent. A healthy 
muscle is, then, dependent on a healthy stomach, heart and 
brain no less than on good food, air, etc., while the more 
refined intellectual processes are also based on a normal 
condition of the physical organs. A person may accom- 
plish much and be a dyspeptic, and so, too, may a cripple 
walk a long distance on crutches. A healthy child, then, 
is better fitted for study than a puny one, and health should 
be the first thing sought in our schools that are educating 
children for the duties of life. For the education of the 
body we may with profit pursue the same pedagogic sys- 
tem that gives good results in mental training. The teacher 
must know something of the existing powers and acquisi- 
tions of the pupil, in order to give proper instruction. In 
schools the daily recitation is an examination into the re- 
sults of study and previous instruction, and the mind of 
the pupil is directed into new channels of thought. 

The inductive method of progress (from the simple to 
the complex), should be followed in the physical as well as 
the mental training of youth. The body, like the mind, 
should be taught the simple principles of exercise, and then 
the complex and intricate movements become easy of mas- 
tery. Then there will be perfect grace of motion, be- 
cause there will be perfect control of every muscle and 
also mental assurance or self-confidence. 

To illustrate the command of the body that results from 



and the Examiner Himself. 75 

systematic physical training, from simple up to complex 
motions, varying for each hand: I have recently been told 
by a physician — an accomplished gymnast — that after prac- 
tising on complex movements with the hands and fingers 
for some weeks he thought he would try to discover 
whether or not it had given him any new control of the 
parts for entirely new work. He had a fair theoretical 
knowledge of music, and played the piano, but had never 
attempted to play on a stringed instrument. He procured 
a violoncello and a book of instruction that showed him 
the theory of the keyboard, the strings, etc. He began 
practice in his spare time and in two weeks could play with 
such ability as to receive and accept a position to play in 
public with an orchestra each week. 

I have repeatedly seen boys, so clumsy and awkward 
that they could not keep step with a squad, while marching 
the length of the gymnasium — boys so self-conscious and 
so lacking in self-control that social life was a burden to 
them — become fairly graceful and easy in movement and 
carriage after a few months* work in the development of 
neglected muscles and the quickening of reflex action by 
nerve exercise and well-balanced activity. 

A clumsy person is, in a certain sense, a sufferer from 
partial paralysis. There are undeveloped nerve centers 
or nerve fibres, that, if not quickened into life, will con- 
tinue to degenerate and in their decay will involve, or, at 
least, affect other centers. The process may be slow, for 
the reflex influence of active parts may arrest the degenera- 
tion to some extent ; but it is not a healthy organism able 
to resist the encroachments of disease or the strain of pro- 
longed work and excitement. 

So practical a business man as the Hon. Thomas G. 
Shearman says : " I do not underrate the value of pure 
mental training, especially as that is nearly all which I 
have myself received ; but my very lack of training in 
physical labor has led me to observe the great value which 
it has not merely with reference to bodily health and 



1 6 .The Uses of Anthropometry 

strength but for the very purpose of enlarging the mental 
faculties'' * 

The acquisition of new powers over reflex or complica- 
ted movements is much more rapid in early life than after 
maturity. The old saying that " It is hard to teach old 
dogs new tricks " had its origin in this tendency to per- 
sistency in any habit of body or mind. A system of edu- 
cation that has in view the symmetrical relations of men- 
tal and physical qualities, can not ignore the necessity of 
beginning physical training with the mental. The child 
should come under the care of an experienced instructor 
in physical training from the day of entrance to regular 
school life. A physical examination should be made that 
should determine the condition of heart, lungs, spine, mus- 
cles, skin, eyes and ears. Many a case of incipient dis- 
ease that eventuates in disaster, would be discovered, and 
put in the care of a physician, if necessary, or a correct 
regime of diet, sleep, exercise, etc., inaugurated with 
the aid of the parents, that would counteract the ten- 
dency to disease or deformity and save the child as a use- 
ful member of society. 

Many parents have no idea that there is serious defor- 
mity that menaces health in their children, until a stranger 
points it out to them. The worst case of varicose veins 
that I ever saw in a young person was found in making 
examinations for a large school, when a son of a physician 
came under my eye. The case was referred to parental 
care and advice, and what was my surprise to learn that 
the father was entirely ignorant of his son's condition ! It 
may not be the province of the State to see that each child 
has medical care ; but, so long as the State takes a child 
from home for five hours out of the day, it is bound to see 
that no physical harm comes to the child in that time ; and, 
if education is for public policy or utility, the care that will 
produce the best citizen is the care that is demanded. 

At the time of this examination a few measurements 

* Rept. of 3rd annual meeting of Amer. Econ. Assoc, Philad., i88g. 



and the Examiner Himself. ly 

should be made and recorded for the direct advantage of 
instructor and child and the aid that all such material will 
give to science. The age, weight, height, height sitting ; 
girth of head, neck, chest, depressed and inflated, waist 
and hips, breadth of shoulders, chest, waist and hips, 
are all important items. There will be only a very small 
per cent, of children in the primary grades that can not 
take the general exercises that will be prescribed, but 
in higher grades the number will increase, and among 
advanced students may reach as high as five per cent. 
Now an advantage of keeping a record of measurements 
will be, that the actual growth under a given system of 
exercise can be seen and, if the progress is not satisfactory, 
the cause may be sought or a new system adopted for 
these cases. The experienced examiner will be aided in 
forming an opinion of the needs of a case, by seeing the 
actual measurements and comparing them with an average 
or standard, while the beginner will rely on them entirely 
until he gets an ideal or standard of excellence fixed in 
his own mind. The child will invariably take more inter- 
est in exercises if he knows what the exercise is for and 
can see that he needs it ; or will feel increased pride in 
keeping ahead of the standard, if he once has passed it. 

After the age of puberty the measurements should be 
more numerous, and should include tests for strength of 
various parts. This will show any minor defects in time 
to modify them during the period of growth ; for after 
this age the boy or girl will have judgment and inter- 
est enough to carry out any regulations that shall have in 
view the strength or beauty of their bodies, and a set of 
measures, or a graphic chart, or both, that will show them 
where their small records are, will greatly reenforce the 
directions that may be given them regarding exercise. 
Again it will help to eradicate from their minds a false 
standard of beauty and symmetry and give them an intelli- 
gent basis of judgment of their own shape. It also enables 
them to see the actual progress that is made under certain 



i8 



The Uses of Anthropometry 



exercises and determines the point of physical maturity 
when further growth stops. 

It will serve as a check to over-development of any part 
which may be quite as injurious to the health as undevel- 
opment ; in short, there is no other intelligent and sys- 
tematic way of undertaking physical training than by 
finding out first, what is needed, and second, prescribing 
exercise that shall build up the weak parts. 

The following simple table has been devised and used by 
Dr. Anderson. Department of Physical Education of the 
Adelphi Academy, Brooklyn, N. Y. 



PHYSICAL CONDITION OF. 



GRADE. 



Date. 









Lung 


What it 








Age. 


Height. 


Weight 


Capac- 
ity. 


should 
be. 









Age 


6. 


7. 


S. 


9. 


10. 


11. 


12. 


IS. 


14:. 


IB. 




Height .. 


46.40 


48.90 


50.17 


52.26 


54-43 


56.86 


57-79 


59-92 


62.53 


64-38 




Weight.. 


47-55 


56.44 


58.09 


63.86 


71.42 


76.17 


81.81 


95.20 


105.15 


113. 81 


CD 
1 •< 


Lung 
Capacity. 


[64 


80 


88 


106 


124 


144 


ISO 


168 


188 


205 




Height .- 


46.11 


47-95 


49.82 


52-03 


53-99 


57.06 


59-17 


60.89 


63.38 


63.12 


9 


Weight.. 


46-55 


50.83 


56.37 


62.32 


71-52 


80.81 


90.68 


99.61 


108 99 


112.80 


Lung 
Capacity 


f- 


40 


48 


65 


80 


106 


125 


136 


15° 


155 





[The above figures show the average height, weight, and about the lung capacity of 
the pupils in a number of the private schools in and near Brooklyn. They are given 
only for comparison. It cannot be said of them that they indicate just what the aver- 
ages should be.] 

Parents are earnestly requested to notify the Physician 
in charge of this department, of Physical Defects, if any, 
that exist in their children, that he may regulate the exer- 
cises accordingly. 



Director Physical Education. 



and the Examiner Himself. ig 

And now a word in regard to the examiner himself : 
It is obvious that a medical training is of very great 
advantage to the person who is to make such physical 
diagnosis and measurement as shall be strictly scientific 
and accurate ; but with the thorough knowledge of 
anatomy and physiology that can be gained in the 
Normal Schools of Physical Education, and a little prac- 
tice under the supervision of a physician who can 
demonstrate abnormal heart and lung sounds, and a 
great deal of practice on normal sounds, the beginner 
need not be lacking in confidence or accuracy of work, 
as he must never be lacking in care. If the examiner 
has not a medical education, let him always err on the 
safe side in a doubtful case and require a certificate 
from a physician before entering on a course of advanced 
exercise, or athletic work. But first let him study the 
case, using all the light that can be thrown on it from 
books and the history that can be obtained. The examiner 
must be a student, he must learn, he must study, examin- 
ing not only the client but books, papers, periodicals. 
Anything bearing on his subject should be studied and 
questioned, but not criticised until he is sure of some 
error ; then let him correct the error by showing its inac- 
curacy of fact or logic. 

Do not take the statement of anybody as infallible. If 
it clashes with your own idea examine it and decide who 
is wrong. 

Do not run after everything new and think that the new 
apparatus will make exercise a pleasure and relieve you 
of your work, or the new idea will save you the trouble of 
thinking. 

Do not go through your work in a perfunctory sort of a 
way, but be enthusiastic and full of interest in those with 
whom you come into the relationship of advisor and 
instructor. 

Be earnest, careful and exact, filled with the spirit of 
hard work, or move on to some less onerous occupation. 



20 The Uses of Anthropometry 

Do not try to find some fault with each person who 
comes under your care, nor continually decry habits that 
you believe to be bad. If you believe, as I do, that the use 
of tobacco is injurious to the majority of smokers, do not 
tell every person, whose breath "gives him away," that 
he is " killing himself " by smoking, or that he has the 
" smoker's heart " and must reform at once if he wishes 
to rob the grave of an early victim ; for in every such case 
you will be either informed that the smoker has no desire 
to go into the business of robbing graves or you will be 
set down as a bigot whose opinion is good for nothing, 
and whose advice is worth still less. If a person asks you 
if you think tobacco has hurt him, and you find no indica- 
tion of injury, be honest enough to tell him so, and your 
candor will so establish his confidence in you that the sub- 
sequently expressed opinion, that tobacco has done him no 
good, will be likely to set him to thinking. At times you 
are expected to express yourself freely, as when lecturing 
on any subject, but do not try to pour a lecture into the 
unwilling ears of everyone who may chance to fall into 
your hands. You do no good but make yourself ridicu- 
lous. 

Establish a record for honesty and ability, and your 
advice will be sought. Integrity is the largest factor in 
influence. 

Endeavor to find out the actual condition of each organ 
and do not be too quick to decide on the cause of any 
abnormality. If the heart action is imperfect and the 
person uses tobacco remember that there are occasionally 
"bad" hearts in those who have never "used the weed." 
A lateral curvature of the spine also may be due to no 
muscular inefficiency or weakness but may indicate good 
muscular action, as in case of a shorter leg on one side. 

Do not be boastful and proudly claim to have discov- 
ered a new " system " or a " natural " system of exercise 
because you have by a certain method of life acquired a 
large biceps or general good physique. Your size of arm 



and the Examiner Himself. 21 

may have as little relation to any system as your size 
of hat. Because Dr. Tanner lived forty days without food 
he did not establish a system of living without food ; and 
because some " Prof." can live comfortably by breathing 
only three times a minute it does not follow that he has a 
" system " all his own ; a turtle can live all winter on one 
breath. 

Be conservative and at the same time progressive. Ex- 
amine all that is new, but before you adopt it test it by 
every standard that you can bring into comparison with it. 
Remember that you will probably not discover a great 
number of new truths, nor will you undermine and over- 
throw many of the commonly accepted theories and doc- 
trines that have been enunciated in the past. 

Be modest, then, and learn much from others, claiming 
very little as entirely new and your own. At the same 
time it is well to remember that this science and art of 
Physical Education or Training is in its infancy, in this 
country at least, and there is much work that is experi- 
mental and tentative. 

Perhaps in no field of scientific research bearing directly 
on practical medicine is more to be discovered and demon- 
strated than in kinetic physiology. The influence of 
exercise on muscle, bone, nerve and connective tissue is 
not fully understood — in fact we are only working at the 
alphabet of the science as it will be developed. Much 
injury to progress has been caused by superficial observa- 
tion and extravagant claims for " systems " and methods 
that had produced fair results apparently with a select 
few and were then loudly proclaimed as a complete scien- 
tific exposition of the whole subject when they barely 
rested on a single correct principle or physiological truth. 
When the enthusiasm of the originator had died out the 
illumination was found to be meteoric and a general dis- 
trust was established. 

A quack in a community injures the reputation of every 
honest practitioner in it. Be content, then, to work a 



22 The Uses of Anthropometry ^ etc. 

great deal and claim very little. Have a scientific theory 
as a basis of your work but be ready to amend it at any 
time. Study your material and you will find so many 
facts to be classified and arranged that you will have little 
time to electrify the world by some universal specific. If 
you have no material and do no work you will have all 
the more time to invent some startling method that shall 
make you rich with the money of fools but leave science 
the poorer by a filching of her name and reputation. 



CHAPTER II. 

THE INSTRUMENTS TO BE USED AND THE RECORDS TO BE 

KEPT. 

For taking the measures of a person several instruments 
are needed ; but the outfit may be very simple. For sev- 
eral reasons the record should be taken and kept in the 
metric system : ist. It is the scientific standard in use in 
all countries, and is in use in every other department of 
scientific investigation. 2d. It enables one to be very 
accurate without trouble, as the unit is very nearly one 
twenty-fifth of an inch. 3d. There are no fractions to 
complicate compilation, or computations, or records. 4th. 
It helps to introduce an improved system of weights and 
measures into general use, and, as the ordinary person has 
no idea whether his record in English units is large or 
small, but only judges by comparison with the standard, 
he will get as good an idea by the metric system. 

The record book should be made of the best ledger 
paper and ruled transversely into spaces enough for all 
the items to be recorded. The perpendicular ruling can 
be made to divide the space into six columns, for the 
records when measurements are repeated. This will 
enable one to see at a glance what the change has been in 
any item, from time to time. If the space is economized, 
there will be plenty of room on the two pages that face 
together to record the measures of three individuals, six 
times each, and keep such items of history as should appear 
in such a book. It is advisable for each examiner to keep 
a private book for containing information of simply a 
personal nature, and for the guidance of the instructor in 
prescribing exercise. 

This private record will give him an amount of material 



BH^£ 



2^ The Instruments to be used 

for study and comparison, in a few years. The books 
should be bound in volumes of about 150 leaves, with 
heavy leather, as they are handled frequently. A second 
way of keeping the records, that has advantages in com- 
piling the figures, or tabulating, has been devised by Dr. 
F. Swain. It consists of a card, with all the items, and 
room for two records of measurements. These cards are 
simply filed in alphabetical order and kept for reference. 
In tabulating results they are sorted over and placed in 
piles, according to any standard that may be taken — as 
height, or weight, etc. It is not a desirable form for a 
permanent record but, as the personal property of the 
examiner, is preferable to a book. 

In the form of record book devised by Dr. Gulick, for 
use in Y, M. C. A. work, the historical data are placed at 
the top third of the page, the remainder being divided into 
a column for prescription, and several narrow columns for 
measures. The number of items measured is smaller than 
the list prescribed by the American Association for the 
Advancement of Physical Education. 

It would seem that the card system of record could be 
used profitably in Y. M. C. A. work, as there is no special 
reason for permanently keeping the data except at some 
central bureau, where they can be tabulated for scientific 
purposes. In schools and colleges a permanent record is 
very important for history and comparison. 

A method of duplicating a record for the benefit of the 
person measured has lately been suggested by Dr. E. 
Hitchcock, Jr., in connection with his graphic chart de- 
scribed later, and consists of a duplicate page to be inserted 
under the record page with a sheet of carbon paper be- 
tween. By writing the record with a stiff pen the figures 
are duplicated on the chart page. This method saves much 
work in copying, and gives each man his record at once on 
a sheet together with the record of an average of 15,000 
college men. This average represents more men of the 
student class than have ever been tabulated before, and is 



and the Records to be kept. 2^ 

therefore the best standard we now have for this class of 
cases. Another very satisfactory method of recording 
measures is by the author's anthropometric table bound in 
book form, and the measures indicated on it by dots and 
lines ; or the actual record can be written at top or bottom 
and the graphic indications marked afterward. This gives 
a person looking over the record for special cases a com- 
prehensive knowledge ol the special form of the subject at 
a glance, where the examination of a list of measures even 
by an expert would be long and unsatisfactory. The pri- 
vate record should contain a careful record of personal 
peculiarities that may have a bearing on health and devel- 
opment. Any history of previous disease or accidental 
injury, even if recovery seems complete, should be recorded. 
Advice in regard to exercise and the results of the advice 
should be noted. This book should be a history of the 
person's physical welfare while he is under observation, 
and thus correspond to a physician's case-book. The 
examiner will learn more from this record than from the 
book recording size and strength. 

The following instruments are needed : 

1. A set of scales, with high bar for convenience in read- 
ing. These are made with metric graduation. 

2. A graduated pole, Fig. i, with a slide moving at right 
angles on it for taking heights. The arm of the slide 
should not be over las""^. long. The pole may have the 
metric system marked on one side, and the English on the 
other, like the one shown in the cut. A very convenient 
method of taking heights is by using two meter sticks, on 
one of which is fixed at the end an arm of metal, 2°^". thick 
and 18'""°. wide and 125'"'". long. A slide bearing a similar 
arm is made to run closely on the stick. The height is 
readily taken by holding the ends of the sticks together by 
the left hand while the right lowers the slide to the top of 
the head. Care must be taken to have the sticks perpen- 
dicular. The height sitting and the height of pubes and 
knee are taken with the one stick, which is much lighter 

3 



BHi 



26 



The Instruments to be used 



and more readily handled than the long pole. The meter 
stick, with slide, can then be used for taking the breadths. 

t^ ^- ---1 T.,;, prs^ 




B. 



Wijj 



G.TIEMANN&CO. gf 



Fiff. 2. 




Fig. I. 
3. A pair of slide calipers, Fig. 2, for taking breadths. 
This must have a capacity of 500™"^. 



and the Records to be kept. 



27 



4. A tape measure of steel or cotton, Fig. 3. The metal 
is uncomfortable to the skin, but does not stretch and can 
be kept clean. A linen tape stretches on being moistened,, 
and many subjects will sweat so freely as to wet a cloth 
tape. A painted tape is about as unpleasant to the touch 
as one of steel, and for the above reasons I always use a 
steel tape. 




Fig. 4. 




Fig. 5. 
A little device is made by the Narragansett Machine Co., 
at the suggestion of Dr. Gulick, for attachment to the end 
of a tape to indicate the proper tension, so that the pres- 
sure may be always alike. It is a good device for the 



28 The Instruments to be used 

beginner, but useless after practice has given a habit in 
making the tension. 

5. Calipers for taking depths, Fig. 4, and, in some cases, 
breadth of chest. These may be of wood or metal and 
should have large extremities, so that a slight variation in 
pressure will not vary the record greatly by indenting the 
flesh. An index should be on the instrument, for reading 
while in position. 

6. A capacity spirometer, Fig. 5, for recording the 
amount of air that can be inhaled and then exhaled, or the 
complemental, tidal, and supplemental air of respiration. 

Hutchinson's wet spirometer is considered the most 
reliable instrument of the kind. 

7. A stethometer or pressure spirometer is used by some 
persons, but is utterly worthless as far as information 
elicited by it is concerned. A person may blow by means 
of a rubber tube and suitable mouthpiece into an ordinary 
steam guage that is made for recording low pressures, or 
an instrument devised by the author may be used. A piece 
of glass tubing of 5™™. diameter is bent into the form of a 
right-angled triangle, having one angle of about 35". The 
side adjacent to this angle should be about 400'°'°. long 
and should be horizontal when the triangle is fixed against 
a flat wall for support. A rubber tube with a glass 
mouthpiece is attached to the short side, and mercury is 
drawn in to fill the horizontal part. Now, by blowing into 
the mouthpiece, the mercury is forced up the hypothenuse 
of the triangle. 

The graduation is easily made by measuring the perpen- 
dicular line from the base to any point in the hypothenuse, 
and affixing a scale to the support back of the tube. The 
pressure will then be indicated in millimeters of mercury 
column. 

8. A hand dynamometer. Fig. 6, for taking the strength 
of the flexor muscles of the forearm. 

There are several forms of this instrument, the more 
common ones being the oval (Fig. 6) and the form with 



and the Records to be kept. 



2g 




JO The Instruments to be used 

the two sides always parallel — the resistance being two 
spiral springs. This second form gives all the fingers an 
equal opportunity to exert their pressure. 

9. Dynamometer for lifting with the back and legs, 
and taking the strength of the pectorals and retractors 
of the shoulders, Fig. 7. This instrument may be replaced 
for the first two tests by a lifting machine with spiral 
spring resistance, and a graduated index applied from 
actual tests. The advantage of this latter form is the 
quick adjustment to the height of the person. 

10. Parallel bars for testing triceps extensor in " Push 
up." A short pair of bars, about 750™™. long, attached to 
a frame with suitable braces, and made to move up and 
down against the wall, in being adjusted to any height 
desired, can be used for this test and also for the *' Pull 
up," or test of flexors of the upper arm. Otherwise a 
horizontal bar, trapeze bar, or pair of swing rings must be 
used for this last test. 

11. A stethoscope for listening to heart and lung sounds, 
etc., Fig. 8. Camman's binaural is a suitable instrument. 
The soft rubber bell (B) is useful at times to secure perfect 
coaptation to the surface of the chest. It requires some 
practice to secure all the advantages that a stethoscope can 
give, as the pressure of the nib in the ear is a distraction 
of the attention, and any slight movement of the fingers 
on the instrument causes vibrations that are not understood. 
If the examiner wishes to hear the valvular sounds of the 
heart, without the interference of muscular vibration 
sounds, he can interpose a thin cloth between the bell and 
skin, but in general the instrument should be placed 
directly against the surface of the body. 

In addition to the above mentioned instruments the 
following are useful at times and for special work : 

12. A sphygmograph, or kymograph, for taking pulse 
tracings, Dudgeon's instrument is perhaps as satisfactory 
as any. It is small, easily applied, can be carried in the 
pocket and used in the gymnasium as well as in the 



and the Records to be kept. 



31 



office. It can not be applied to all pulsating surfaces. 
Marey's instrument is used to some extent, but the pneu- 
matic kymograph is employed in all physiological labora- 
tories, and does very satisfactory work. 

13. A laryngoscope, rhinoscope, otoscope and tuning 
fork, for examining the throat, nose and ears. 

14. A Clinical thermometer. 

15. A Pleximeter and percussor. Figs. 9, 10. 

A 16. Microscope of 20"''". focal distance for examining 
the skin. 




F 9 




Fig. 10. 

17. A case of urinary tests for sugar and albumen. 

18. Test worsteds, glasses, and charts, for examination 
of eyes for color blindness and errors of refraction. 

These instruments can be obtained of any first-class 
dealer in surgical instruments and optical goods except 17 
which can be obtained of Parke, Davis & Co., or other 
manufacturing chemists and druggists. 

A universal dynamometer has been invented by Dr. J. 



J2 Tne Instruments to be used 

H. Kellogg, which deserves more than a mere mention for 
it is destined to be used in modified form by every person 
practicing anthropometry, and by many physicians in 
diagnosis and determination of the actual progress of cer- 
tain cases. Its use will supply the place of all the dyna- 
mometers mentioned above, while its cost will be compar- 
atively small. 

The instrument may be briefly described in the words of 
Dr. Kellogg, transcribed from a paper published in the 
Transactions of the Michigan State Medical Society, 1888 : 

" I. A cistern about two-thirds filled with mercury, the 
remaining space being filled with water. 

" 2. A glass tube of a caliber of about one thirty-second 
of an inch and six feet in height. 

'^ 3. A rubber bulb connected by a tube with the space 
above the mercury in the cistern, and both filled with 
water. 

" 4. A bottle partly filled with water, placed two or three 
feet above the cistern and connected with the upper part 
of it by a rubber tube. A pinch cock controls the connec- 
tion between the bottle and the cistern. The purpose of 
this arrangement is to keep the upper portion of the 
cistern filled with water, and to raise the height of the 
column to any desired point before applying pressure to 
the bulb when it is desirable to do so. 

" 5. An adjustable, graduated scale erected beside the 
glass tube and reaching to the level of the mercury in the 
cistern. 

*' 6. A framework by which the apparatus is sustained. 
See Fig. 23, page 16. 

" In use compression is made on the rubber bulb by 
which water is forced into the cistern displacing an equal 
quantity of mercury which rises in the tube until a height 
is reached at which the pressure upon the inside of the 
bulb is equivalent to that upon the outside. 

" By means of simple arrangements for the purpose, the 
strength of every group of muscles in the body, except the 



and the Records to be kept. 



33 



smallest and most inaccessible, can be readily tested by 
this apparatus." 

The following cuts will illustrate the method of using 
the apparatus for some of the common tests. 




Fig, II. 

" Fig. 1 1 shows the method of testing the anterior 
muscles of the leg. It is simply a double lever moving 




Fig. 12. 
upon an axis in the center, the bulb of the instrument 
being placed under one end and the toe of the foot under 
the other end. The test is made by raising the toe. 



34- 



The Instruments to be used 



"Fig. 12 shows the method of testing the muscles of the 
calf. The bulb is placed beneath a bar secured to two 
uprights, being supported by a flat piece which rests upon 
the knee. By raising the leg by the toe, the muscles of 
the calf are brought into action. 




Fig. 13- 

" Fig. 13 shows the method of testing the muscles of the 
shoulders. 




Fig. 14. 



and the Records to be kept. 



35 



" Fig. 14 shows the method of testing the diaphragm. 
The apparatus used is seen more distinctly in Fig. 15. It 
consists simply of a belt carrying two rigid plates, one fixed 
and the other movable, secured together by rubber bands. 
The screw which passes through the fixed belt works 
against another movable plate on the inside of the fixed 
plate, and furnishes a means of fine adjustment. In use 
the belt is put around the body so that the movable plate 
falls just below the ribs. After attaching the belt the 
screw is turned in until the mercury rises in the column to 
ten centimeters, then the patient takes a deep abdominal 
breath. The same instrument may be used for testing the 
strength of the serratus magnus, by placing it at the side 
instead of the front. 




Fig. 16. 



"Fig. 16 shows the method of testing the pronators and 
supinators. 

"Fig. 17 shows the method of testing the force with 
which the hands can be pressed together. 



3^ The Instruments to be used 

11 




Fig. 38, 
UniTersal MercuriaZ I)ynamometer 



and the Records to be kept. J7 

** Fig. 1 8 shows the method of testing the flexor muscles 
of the arms. The extensors and flexors of the legs are 
tested by similar means. 



Fig. 17. 

'' A strap is thrown over the shoulders, with the body- 
bent forward at an angle of 45 degrees for the purpose of 
testing the strength of the muscles of the back. A similar 
arrangement attached to the wall is used to test the 
anterior and lateral muscles of the trunk, also the muscles 
of the neck. You can readily see how by a simple con- 
trivance all the principal groups of muscles in the body 
may be tested. My instrument has a mercurial tube 10 
feet long. A much shorter tube will answer the purpose 
by having the top of the tube closed." 

Some modifications of this machine will adapt it to 
general use. If a closed tube seven or eight feet long be 
used the top may be doubled on the main part for two 
feet to save space and make the apparatus more portable. 
If the calibre of the tube be small there will be no need of 
the hydraulic pressure from the bottle of water shown in 
the illustration, Fig. 23. For ordinary tests there will be a 
record of less than 200 lbs., except for back and legs. To 
take these heavier tests a system of levers will be required 
and can be readily arranged. 

One point in the working of this machine that must be 



3S 



The Instrume^tts to be tised. 



secured before perfect accuracy will be reached is the con- 
dition of similar pressure surfaces on the bulb for every 




Fig. i8. 

test. Then the record can be read in a similar unit for 
each test and will be absolute. This will enable one to 
compare or tabulate records made on different machines 
of the same kind, as we now compare weights taken on 
different scales. The author has devised an arrangement 
that will apparently meet this requirement for the majority 
of tests but must have practical experience with the 
apparatus before announcing a complete machine. Any 
new device that will enable one to secure accurate tests of 
strength will assist greatly in practical anthropometry and 
the prescription of exercise. 



CHAPTER III. 

WHAT TO MEASURE AND HOW TO MEASURE. 

In making a physical examination and measurement it 
is well to have the subject entirely nude, and consequently 
the temperature of the room must be kept as high as 75°. 
A good method of procedure is to take the weight and 
height measurements, then the lengths, then the breadths, 
then the depths, then the girths, and finally the strength 
tests. During the measurement the examiner should be 
alert in noticing any peculiarity or deformity or disease or 
external indication of disease. The subject may then dress 
the lower extremities, and the minute examination of the 
chest be continued. 

When the examination is made for an institution, and is to 
include the measurement of many men, the services of a 
clerk will save at least half of the time and leave the exam- 
iner free from merely clerical work, and enable him to give 
all his attention to the examination in hand. With such 
assistance the fifty measurements can easily be made, after a 
little experience, in five or six minutes, and from fifteen to 
twenty minutes should be devoted to each individual ; the 
latter amount if advice in regard to methods and forms of 
exercise, and instruction concerning diet, bathing, sleep, 
etc., is to be given at the time of the measurement. To 
economize time the specially weak or undeveloped parts 
should be pointed out to the subject himself and the sim- 
plest exercises for developing those parts be recommended 
and illustrated if possible. 

A greater advantage will come from exercise if the ob- 
ject of the exercise is known than if a routine is simply 
followed without interest. A muscle will undoubtedly 



4-0 What to Measure and How to Measure. 

grow faster if watched and made the object of thought dur- 
ing its activity, and if attention is turned to it during its 
period of rest. The reason of this is found in the inter- 
relation of the trophic and voluntary nerves. 

A proof of the influence of volition over trophic changes 
has lately been made by Prof. A. Lehmann of Copenhagen, 
who has employed a thermometer capable of showing dif- 
ferences of .02° F. When Lehmann or the person who 
aided him in his experiments, concentrated his mind on 
the idea of an increased temperature of the hand, it rose 
.036° to 0.108° F. ; but when the attention was concentrated 
on the idea of a greater warmth of the fingers alone, the 
temperature of the hand fell 0.756° to 0.936° F. — Hospital- 
stidende, No. 3, 1890. Copenhage?i. 

The hygienic instruction can be given by lecture to whole 
classes, and a case needing special care and supervision 
can be asked to come to your office at some other hour 
when you will have time to go over the case thoroughly 
and examine into all the details of his habits, a knowledge 
of which will alone enable you to give the best advice. 

If you are examining many cases in succession, you will 
need to possess a quick memory of faces and facts, or some 
notes will have to be taken at the time of examination, 
that will recall the existing conditions in each case. It is 
well to train the memory in this matter, but to take careful 
notes to fall back upon. A client will feel that you re- 
member him and have given his case thought, if you can 
show him that you know just what his condition was when 
you saw him last. 

The number of items measured is not of so much impor- 
tance as the thoioughness of the work done, and the care 
and judgment displayed in discovering weak parts that can 
be strengthened, and recommending the proper remedies. 
But I would advise a strict adherence to the advanced stan- 
dard of measurements recommended by the American As- 
sociation for the Advancement of Physical Education and 
for three reasons : ist, to take this complete list would re- 



What to Measure and How to Measure. ^i 

quire only about two minutes longer time than for the 
method of twenty items. 2nd, the completeness of the re- 
cord will be a satisfaction to all parties. 3rd, uniformity 
of methods is of great importance in giving scientific value 
to work of this kind. Then, if a person has a special de- 
sire to ride some hobby of his own and take such measure- 
ments as the horizental length, the occipito-mental diame- 
ter of the head and the length of the os calcis, all of which 
points are of some importance and have a bearing on 
anthropology and practical anthropometry, he is at liberty 
to do so. 

Below is given in full the report of the committee on 
statistics appointed by the American Association in 1885. 



Report of the Committee on Statistics, appointed by the American 

Association in iSS^, giving the detailed method of securing 

measurements, tests, and the condition of the human body. 

ANTHROPOMETRIC MEASUREMENTS. 

Number. — In order to secure privacy the individual 
should be entered in the record book by number. As a 
means of identification the number can be entered in an 
alphabetical index book opposite the corresponding name, 
as : 

Smith, John H., 526. 

For further convenience it is advisable to enter the name 
in a numerical index book opposite the corresponding 
number, as : 

526, John H. Smith. 

Date. — Record the year, month, day and hour, as : Jan., 
'86, 12, 9 A.M. Where perfect accuracy is desired, note 
should be made of the time that has elapsed since eating, 
the occupation of previous hours, and of the temperature 
of the room. 

Age. — Record years and months, as : 21, 9, /. e., twenty- 
one years and nine months. 
4 



^2 What to Measure and How to Measure. 

Weight. — The weight of the body should be taken with- 
out clothes. Where this is impracticable the weight of the 
clothes should be deducted. 

Height. — The height should be taken without shoes and 
with the head uncovered. The head and figure should be 
held easily erect, and the heels together. This position is 
best secured by bringing the heels, the buttocks, the spine 
between the shoulders and the back of the head, in contact 
with the measuring rod. 

Height of Knee. — The subject should place one foot on 
a box or chair of such a height that the knee is bent at a 
right angle. A box about 12 inches high is suitable for 
adults. Press a ruler upwards with a force of about one 
pound against the ham string tendons close to the calf of 
the leg. See that the ruler is held in a position at right 
angles to the vertical rod, and measure the height of the 
top of the ruler from the box. 

Height Sitting. — Let the subject sit on a hard, fiat sur- 
face about 12 inches high, such as afforded by a box or 
chair, with the head and figure easily erect so that the 
measuring rod will touch the body at the buttocks, between 
the shoulders, and at the back of the head. Measure the 
distance from the box to the vertex. 

Height of Pubes. — With the subject standing easily 
erect on the box or floor, measure up to the lower edge of 
the pubic bone. 

Height of Crotch. — With the subject standing easily 
erect on the box or floor facing the vertical rod, press a 
ruler firmly against the perineum (crotch) and measure 
the height of the top of the ruler. 

Height of Navel. — With the figure and head of the 
subject erect, measure the height of the centre of the 
cicatrix. 

Height of Sternum. — With the figure and head of the 
subject erect, measure the height of the interclavicular 
notch. 

All girths should be made on the skin itself at right 



W/ia^ to Measure and How to Measure. 4.J 

angles to the axis of the body or limb at the point of 
meas'irement. No oblique measurements are taken. 

Girth of Head. — This measurement should be taken 
around the head with the tape at the upper edge of the eye 
brows, over the supra orbital and occipital prominences. 

Girth of Neck. — With the head of the subject erect, 
pass the tape around the neck half way between the head 
and body, or just below the " Adam's Apple." 

Girth of Chest. — Pass the tape around the chest so 
that it shall embrace the scapulae and cover the nipple. 
The arms of the subject should be held in a horizontal 
position while the tape is being adjusted and then allowed 
to hang naturally at the sides. Take the girth here before 
and after inflation. 

Where it is desirable to test the elasticity or extreme 
mobility of the walls of the chest, a third measurement 
may be taken after the air has been forced out and the 
chest contracted to its greatest extent. To test the respira- 
tory power, independent of muscular development, pass 
the tape around the body below the pectoral line and the 
inferior angles of the scapulas, so that the upper edge shall 
be two inches below the nipples. Take the girth here 
before and after inflation. 

Girth of Waist. — The waist should be measured at the 
smallest part after a natural expiration. 

Girth of Hips. — The subject should stand erect with feet 
together. Pass the tape around the hips above the pubes 
over the trochanters and the glutei muscles. 

Girth of Thighs. — With the feet of the subject about 
six inches apart, the muscles set just enough to sustain the 
equilibrium of the body and the weight distributed equally 
to each leg, in gluteal fold measure around the thigh just 
below the nates. 

Girth of Knee. — With the knee of the subject straight 
and the weight of the body equally supported on both legs, 
measure over the centre of the patella. 

Girth of Calf. — With the heels down and the weight 



^<^ What to Measure and How to Measure. 

of the body supported equally on both feet, the tape should 
be placed around the largest part of the calf. 

Girth of Instep. — Measure around the instep at right 
angles with the top of the foot, passing a point at the bot- 
tom of the foot midway between the end of the great toe 
and back of the heel. 

Girth of Upper Arm. — With the arm of subject bent 
hard at elbow, firmly contracting the biceps and held away 
from the body in a horizontal position, pass the tape 
around the greatest prominence. If desirable to find the 
girth of the upper arm when the biceps is not contracted, 
the arm should be held in a horizontal position and meas- 
ured around the most prominent part. 

Girth of Elbow. — Taken around the internal condyle 
of the humerus while the arm of the subject is straight, 
with the muscles of the forearm relaxed. 

Girth of Forearm. — Taken around the largest part. 
The fist should be firmly clinched and the palm of the 
hand turned upward. 

Girth of Wrist. — With the hands of the subject open 
and the muscles of the forearm relaxed, measure between 
the styloid process and the hand. 

Breadth of Head. — The breadth of head should be 
taken at the broadest part. In taking the breadth meas- 
urements, stand behind the subject. 

Breadth of Neck. — Taken at the narrowest part with the 
head of the subject erect and the muscles of the neck relaxed. 

Breadth of Shoulders. — With the subject standing in 
a natural position, elbows at the sides, shoulders neither 
dropped forward nor braced backward, measure the broad- 
est part two inches below the acromion processes. 

Breadth of Waist. — Taken at the narrowest part. 

Breadth of Hips. — Measure the widest part over the 
trochanters, while the subject stands with feet together, 
the weight resting equally on both legs. 

Breadth of Nipples. — Taken from centre to centre 
with the chest in a natural position. 



What to Measure and How to Measure. ^5 

Depth of Chest, — Taken after a natural inspiration. 
Place o.ne foot of the calipers on the sternum midway 
between the nipples, and the other foot on the spine at 
such a point that the line of measurement is at right 
angles with the axis of the spinal column. When it is 
desirable to ascertain the extent of the antero-posterior 
movement of the chest, measurements may be taken from 
the same points after the fullest inspiration and after the 
fullest expiration. 

Depth of Abdomen. — Place one foot of the calipers 
immediately above the navel, the other on the spine at 
such a point that the line of measurement is at right 
angles to the axis of the spinal column. 

Length of Shoulder to Elbow. — With the arm of the 
subject bent sharply at the elbow and held at the side, 
measure from the top of the acromion process to the 
olecranon. Care should be taken that the measuring rod 
is parallel with the humerus and not with the external 
surface of the arm. 

Length from Elbow to Finger Tip. — With the arm of 
the subject bent sharply at the elbow and the rod resting 
on back of arm and hand, measure from the olecranon 
process to the tip of the middle finger. 

Length of Foot. — Take the extreme length of foot 
from the end of the first or second toe to the back of the 
heel, about one inch from the surface upon which the foot 
rests. 

Stretch of Arms. — With the arms of subject stretched 
out horizontally so that both hands and shoulders are in a 
line, with one middle finger and the zero end of the meas- 
uring rod pressed against the wall, note the point to which 
the other middle finger tip reaches. 

Horizontal Length. — With the heels of the subject 
pressed hard against a perpendicular wall, with arms at 
the sides and body resting naturally on a horizontal plane, 
measure the distance of the apex of the head from the 
wall. 



/j-d What to Measure and How to Measure. 

Capacity of Lungs. — The subject after loosening the 
clothing about the chest and taking a full inspiration, 
filling the lungs to their utmost capacity, should blow 
slowly into the spirometer. Two or three trials may be 
allowed. 

Expiratory Strength. — As before, the subject after 
loosening the clothing about the chest and filling the 
lungs completely, should blow with one blast into the 
manometer. Care should be taken that no air is allowed 
to escape at the sides of the mouth, and that in expelling 
the air all the muscles of expiration are brought into play. 

Strength of Back. — The subject, standing upon the 
iron foot-rest with the dynometer so arranged that when 
grasping the handles with both hands his body will be 
inclined forward at an angle of 60°, should take a full 
breath and, without bending the knees, give one hard lift, 
mostly with the back. 

Strength of Legs. — The subject while standing on the 
foot-rest with body and head erect, and chest thrown 
forward, should sink down, by bending the knees, until 
the handle grasped rests against the thighs, then taking a 
full breath, he should lift hard principally with the legs, 
using the hands to hold the handle in place. 

Strength of Chest. — The subject with his elbows ex- 
tended at the sides until the forearms are on the same 
horizontal plane and holding the dynamometer so that the 
dial will face outward and the indicator point upward, 
should take a full breath and push vigorously against the 
handles, allowing the back of the instrument to press on 
the chest. 

Strength of Upper Arms, Triceps. — The subject, while 
holding the position of rest upon the parallel bars, sup- 
porting his weight with arms straight, should let the body 
down until the chin is level with the bars, and then push 
it up again until the arms are fully extended. Note the 
number of times that he can lift himself in this manner. 

Strength of Upper Arms, Biceps. — The subject should 



W/ia^ to Measure and How to Measure. ^7 

grasp a horizontal bar or pair of rings and hang with the 
feet clear from the floor while the arms are extended. 
Note the number of times that he can haul his body up 
until his chin touches the bar or ring. 

Strength of Forearms. — The subject, while holding 
the dynamometer so that the dial is turned inward, should 
squeeze the spring as hard as possible, first with the right 
hand then with the left. The strength of the muscles 
between the shoulders may be tested with the same instru- 
ment. The subject, while holding the dynamometer on a 
level with the chest, should grasp it with handles and pull 
with both arms from the centre outward. 

PiLOsiTY. — Note the amount of hair on the body and 
limbs, excluding the head, face and pubes. 

Color of Hair. — Light (Very Fair, Fair, Light Brown, 
Brown), Dark (Dark Brown, Black Brown, Black). Red 
(Red Brown, Red, Golden). 

Color of Eyes. — Light (Dark Blue, Blue, Light Blue). 
Dark (Light Brown, Brown, Dark Brown, Black). Mixed 

(Gray, Green). 

D. A. Sargent, \ 

Edw. Hitchcock, >• Committee. 

Wm. G. Anderson, ) 

The following criticisms of this Report, that now stands 
as the official list of the Association, are presented, and an 
effort will be made at the next annual meeting to have the 
list revised, and the changes here suggested incorporated. 

The height of knee should be a bone measurement, and 
the most convenient point is to top of the fibula, as the 
subject is sitting, and this record can be taken immediately 
before or after " height sitting." The present method is 
very inaccurate and unscientific, because the length will 
vary from two to five cm., according to the tension of the 
hamstring muscles, which are not always under the direct 
control of the will with the leg in the position indicated 
and can not be relaxed in every case without great care. 



/j-S What to Measure and How to Measure. 

The head of the fibula can be easily found in nearly every 
case, and in those where it can not be located, the head of 
the tibia can be found, and the head of the fibula is about 
ten mm. shorter. The " height of crotch " need not be 
taken, for obvious reasons, when we have " height of 
pubes." 

Another height-measurement advised by the Y. M. C. A. 
committee is the length of trunk which is measured from 
the buttocks to the point of the seventh spinous process, 
or vertebra prominens, with the subject in the same posi- 
tion as for taking the height sitting. It is not always easy 
to decide with certainty which is the seventh spinous pro- 
cess ; but it is usually the most prominent one, and of 
several that seem of equal prominence, it is usually the 
lowest. 

The length of trunk, depth of chest and breadth of chest 
are three factors, that, multiplied together, may roughly 
be considered to represent the "vital capacity" of a 
person. We can get the length of trunk in another way — 
by subtracting the height of sternum from total height, 
which will give the length of head and neck ; and, by sub- 
tracting this remainder from the height sitting we shall 
have the length of trunk. 

I can discover no adequate reason for taking the hori- 
zontal length. It consumes considerable time, is a difficult 
measurement to take correctly, and exceedingly awkward 
for the subject ; its average relation to the total height is a 
matter of anatomical record ; and, in the special case it 
can easily be estimated by any examiner, of even limited 
experience, by the amount of lordosis and flexibility of 
the spine. Each person should take a few measurements 
of subjects with hollow backs, in order to get an idea of 
the vai'iation in these cases ; but further than this there is 
no utility in the recording of this item. In taking girth of 
elbow the object is to discover the development of the 
tissues that lie between the muscles measured in the arm 
girth and those in the forearm girth. The muscles of the 



What to Measure and How to Measure. /fg 

forearm have their origin on the internal and external 
condyles, without the intervention of tendon. A measure- 
ment over the condyles is therefore essentially the same 
as the forearm girth and will in practice differ from it by 
only about two centimeters. We would discover the con- 
dition of the whole arm, and the elbow girth taken over 
the condyle adds nothing to our information. On the 
contrary, if we measure around the smallest part of the 
elbow we know how well the tissues are developed 
between the muscles of the arm and those of the forearm. 
It is not a muscle girth in the latter case ; in the former it is. 

The breadth of shoulders should be a bone measurement 
as nearly as possible ; for I conceive the object of it to be 
the determination of the extent of the bone tissue to which 
the more important muscles of the upper extremities and 
thorax are attached. If we measure below the acromion, 
as directed, we give a person credit for broad shoulders 
simply because he has a thick deltoid muscle and the 
muscles of the chest and arm add to the record, in such 
cases, by making the arm hang at an angle instead of per- 
pendicularly, as expected. It would be nearly as scientific 
to include the arms in the waist breadth, and then let the 
subject stand with arms akimbo. 

The breadth of chest is of more importance than breadth 
of nipples and should be taken at full natural inspiration 
in the axillory regions, on a level with the nipples. For 
ordinary cases the measurement can be taken with the same 
instrument as the other breadths ; but in very fat or muscu- 
lar persons the calipers used in taking depths should be used. 

The expiratory strength, as ordinarily taken, is mislead- 
ing and untrustworthy. The intention is to gain some 
knowledge of the condition of the accessory muscles of 
expiration ; for, in ordinary expiration there is little or no 
activity of muscles but rather a letting go or suspension 
of muscular effort. (See Foster. Phys. ed. 1883, p. 315.) 
Now, when the subject is asked to blow as hard as he can 
into the apparatus, and keep the throat open, as in respira- 



JO What to Measure and How to Measure. 

tion, he will involuntarily close the pharynx with the 
back of the tongue and palate, and then bring the muscles 
of the cheeks and lips into active contraction, and, with a 
few efforts, acquire such skill as to rival the cornet player 
in the record secured. 

For those who are making a special study of athletes a 
measurement suggested by Dr. Savage of the Berkeley 
Lyceum Gym. is worthy of notice, namely ; the length of 
the OS calcis ; this being the lever arm of the muscles that 
extend the foot ; its relation to the metatarsal and phalan- 
geal portion is doubtless of importance in determining the 
ability for such exercises as running, walking, jumping, etc. 

Some points in minute anthropometry have been sug- 
gested by various specialists, but obviously such work 
should be left to those who wish to study some particular 
phase of the subject. 

Dr. F. Swain has proposed to measure the height of 
ear, girth of ankles and hands, depth of pelvis, neck and 
head, length of hands. Mr. R. J. Roberts considers the 
girth around the shoulders at point of shoulder breadth 
of great importance. Dr. E. Mosher thinks that depth of 
chest should be a double measurement, showing thickness 
of right and left chest ; and the suggestion is a good one, 
because, in many cases the sternum is depressed and the 
record, if made strictly by rule, would be smaller than the 
subject deserves. In such cases I have put one foot of the 
calipers on the proper point behind, and brought the other 
out to a point not quite in line with a ruler laid across 
the chest. Dr. Mosher's method would show any asym- 
metry of the chest. 

The French police regulations require a minute measure- 
ment of the ear and middle finger for identification of 
criminals if they are arrested a second time. These meas- 
ures help in classifying the photographs that are taken so 
that they can be readily found among thousands. Some 
form of anthropometrical tests can no doiibt be made more 
serviceable in establishing identity in a " rogue's gallery " 



What to Measure and How to Measure. 57 

than photography. The physiological picture of a man as 
shown on a graphic chart is sure to retain some character- 
istic feature, whatever may be his condition. 

Photography may be wisely used as an adjunct of 
anthropometry. Since Prof. Muybridge made his won- 
derful pictures of animal locomotion by instantaneous 
process the value of a photograph to show physical defi- 
ciencies as well as excellence has been established. It 
makes a record in an artistic way that is made by tape and 
calipers in a mathematical or scientific way. Already at 
some of the better equipped gymnasiums, like the Hemen- 
way in Cambridge, photography is made to assist in pre- 
serving the record of a man's physical condition. 

The strength tests that may be taken are more in number 
than the muscle girths taken in the above list and a table of 
strength tests may be made that would correspond to the 
author's anthropometric table. The quality of the muscles 
could be graphically shown on this, side by side with the 
girths. Uniformity of method in testing strength will soon 
furnish material for such a table. Care must be used to 
guard against strain and over-exertion in securing data 
of strength. 

The tests for accuracy and strength may be made by 
the record in a series of athletic exercises and show some- 
thing of the nerve training that the subject has had ; — in 
other words, the self-controlled power. In a person we may 
test the strength of fifty groups of muscles acting separate- 
ly so far as possible and, while our record may be high, 
we may still have a very inadequate estimate of the coordi- 
nated power — the real strength of the individual, which 
may be small. Probably the best exhibit of a man's 
power is seen in such games as foot ball where the 
strength of every muscle is tested both as to its own 
quality and its adjustment to other muscular groups and 
to mental stimuli. 

An organ may work correctly but slowly. The eye of 
one person sees at a glance what the eye of a second 
person would require seconds to reveal, and yet the eye 



^2 What to Measure and How to Measure. 

of the latter may be perfect according to every test of the 
oculist. It is so with hearing. The time required between 
hearing and perceiving sounds and giving a signal is .12 
to .18 of a second. Higher tones require slightly less 
time than deeper ones. Noises are heard quickest.* 

A distinguished teacher recently told me that he had 
called a certain boy stupid until he discovered that the boy 
was merely slow in his sense of hearing. Since that time 
he has studied boys whose perceptive faculties seemed 
dull and has found that a large percentage of them are 
deficient mainly in hearing a question that is put rapidly 
to them. A device that will test the speed of the action of 
the eye and ear correctly within moderate limits of accu- 
racy will be of great practical importance in an educa- 
tional as well as scientific aspect. Physical education 
must bring up to a higher plane of activity each physical 
function that is found to be deficient. To do this the 
examiner must be ever alert to discover undeveloped 
functions and inventive ability will be frequently required 
to solve the problems presented. 

Another refinement of anthropometry is taking the 
specific gravity of a man. This may. not be a feasible 
addition to practical anthropometry but for minute study 
may afford an interesting field of investigation. The 
record can be taken by immersing the subject to the face 
or any suitable point in a reservoir of water that is situat- 
ed on a scale for weighing. From the weights of the 
reservoir full of water, the displaced water and the im- 
mersed subject in the reservoir the specific gravity has 
been calculated. The fact has been often noted that men 
of small girths often show a weight far above what would 
be fairly estimated, but as yet there has been no scientific 
study of this class of cases to discover the relation of high 
specific gravity to health, strength, endurance or longevity. 
The specific gravity of any body is represented by the 
quotient obtained b)^ dividing the weight of the body in 
air by the loss of weight when weighed in water. 
* Kries and Auerbach, quoted by Thompson. 



CHAPTER IV. 

PERSONAL HISTORY AND EXAMINATION OF SPECIAL SENSES. 

The historical data that should be gathered at each 
examination are of varied character, and of the highest 
importance. It gives the examiner an idea, not only of 
the immediate weaknesses that are to be met and combated 
by proper advice and training, but it places the law of 
heredity in bold relief, and enables the counsel to be far- 
reaching in its results. 

For instance : with a record of tuberculosis, extending 
through two or more generations, there would seem to be 
sufficient warrant for advising not only the thorough devel- 
opment of the chest, but the careful avoidance of excessive 
exercise, such as would be required in many athletic sports 
that would seem, at first thought, especially suitable for a 
person of consumptive diathesis. To know a man well 
you must know his father and grandfather. This negative 
side of training and physical education has received very 
little attention from practical teachers outside of the so- 
called Delsarte system, where it has run riot. The con- 
servation of force is the foundation of the Delsarte system, 
but only profound ignorance of the physiologic laws of 
growth and development could excuse the building upon 
such a principle. 

Growth and organic perfection are gained only by a use 
of all the tissues — but use is one thing and abuse quite 
another. The eye is developed and improved by a repeated 
use in distinguishing colors, shapes and sizes ; but a long- 
continued strain of the eyes over a Greek or German text 
is not exactly beneficial, as the spectacle-mounted noses 
of our students, especially the Germans, bear witness. So, 



^/j. Personal History and Examination 

while a good run in the open air may be beneficial to a 
person of sensitive or weakened lung tissue, it does not 
follow that training for a mile run or a " hare-and-hounds " 
chase would be. 

The condition of the subject during the previous years of 
his life is valuable in making a prognosis or a judgment of 
the future history of the case, and in deciding what quality 
of endurance the subject possesses, for the violent exercise 
of one man is a mere nothing for another. The boy who 
comes to school from the farm or workshop may be no 
better developed than his classmate, who has never known 
what physical v/ork is, and yet be able to endure twice as 
much prolonged physical exertion. His life has been 
spent out of doors, and he takes kindly to outdoor sports, 
running, foot-ball, boating, etc.; or, if his life has been in 
a shop where skilled manipulation has engaged his energy, 
he prefers gymnastic exercises, becomes an adept at club 
swinging, fencing, etc., or a good performer on the bars, 
rings and other apparatus. 

The city-bred boy has a latent aptitude for anything, and 
with proper training is a strong competitor with his 
country classmate in every line of athletics or gymnastics, 
but his exercise will need to be progressive, or he will 
suffer from local strains that may affect vital organs. 

If, on the other hand, the history discloses a previous 
life of activity and physical hardship, and the plan of life 
is directed toward sedentary pursuits, the recommendation 
must be toward retrogressive exercise. A man with benign 
hypertrophy of the heart is not in the best condition for 
sitting at a desk all day — there will be too much local con- 
gestion for good brain work, or the metamorphosis of 
muscular tissue in the heart itself will end in fatty degen- 
eration, or softening, and impaired vitality result. This is 
undoubtedly the reason for the numerous cases of func- 
tional and organic diseases of the heart that are found 
among ex-champions. 

The history may also disclose a tendency to disease in 



of special Senses. 55 

the subject himself, that will modify the prescription of 
exercise very materially, if the examiner is alive to the 
exigencies of the case and informed as to its requirements. 

But, without citing further examples of the advantages, 
nay, necessity of a full history of each case, let us turn to 
the question of what points in history should be recorded. 

On the record book, in connection with the measures, 
the subject's name and birthplace should be kept — there is 
no reason for secrecy about these matters. — It is also well 
to add the birthplace of parents and grandparents to this 
general record, for it makes the material valuable in study- 
ing the effect of location or environment in differentiating 
classes or social groups ; the occupation of the father, the 
resemblance in physical build to father's or mother's family; 
past exercise in work and recreation, pulse rate, color of 
hair and eyes, vision and hearing, use of tobacco and stim- 
ulants. In the private book should be recorded the cause 
of death of either parent if not living, any disease that has 
been common in the family (it is better not to use the word 
hereditary in this connection) such as lung diseases, heart 
diseases, rheumatism, neuroses, Bright's disease, cancer, 
scrofula, varicose veins, dyspepsia, diarrhoea, constipation, 
catarrh, etc. ; also any disease that may be found affecting 
the subject, as varicocele, rheumatism, synovitis, etc., any 
deformity and its cause, if discoverable ; any injury in the 
way of broken bones, surgical operations, strains, etc.; any 
previous severe illness, such as peritonitis, zymotic fevers, 
etc.; any tendency to deranged functional activity, as con- 
stipation, biliousness, indigestion, insomnia, etc. 

In this connection it may be well to call attention to the 
rule that, if a child strongly resembles in physical build 
the side of the family that has no hereditary taint, the 
other side having some pathological diathesis or dyscrasia, 
the probability of his inheriting the disease is diminished. 

It is well to record the special kind of athletic or gym- 
nastic work that has been taken, and whether this has been 
under the personal direction of a teacher or trainer. If 



^6 Personal History and Examination 

there is any lesion of the heart or other organs that has 
been due to or been attributed to athletic or gymnastic 
work under supervision, look up the instructor and get the 
previous history of the case. You may find that the so- 
called instructor or trainer was an ex-prize fighter or 
dilapidated "bummer," but, if so, use him to discredit the 
popular trust in ignorance. If he does know his business, 
he will perhaps be able to enlighten you as to the cause of 
the trouble. 

The record of color-blindness* should be kept, not as a 
disease, but as a peculiarity that would render the subject 
unfit for some occupations. In many cases of supposed 
color-blindness, the sense is probably simply uneducated. 
Cases of color-blindness among women are very rare (i 
in 25,000) and are not frequent among men. The eyes 
should be examined by a specialrst in opthalmology if there 
is the slightest indication of nerve irritation, and the super- 
ficial examination, such as is indicated here, shows the 
slightest error of refraction or muscular insufficiency.! 

Tests of the hearing may be made, and any dullness or 
difference in the auditory sense of the two ears should lead 
to an examination with the otoscope. The channel may 
be partially or completely occluded with wax or the debris 
from a previous inflammation or an exostosis of the wall 
of the meatus. If the opening is normal, the tympanum, 
or drum, will be seen at a depth of about two centimeters 
as a smooth, shining, semi-transparent membrane of slightly 
pinkish-gray color. In cases of inflammation the drum 
becomes decidedly pink. Slightly below and in front of 
the center is a white spot as though some white body 

* See page 61 for directions for testing special senses. 

f See the New York Medical Journal iox Januarj' 7 and 14, 1888, and 
the same journal February 27 and March 13, 1886, containing articles 
by A. L. Ranney, M.D., on The Treatment of Functional Nervous Dis- 
eases by the Relief of Eye-Strain, etc. Also the Belgian Prize Essay, 
by Dr. Stevens, of New York, and the Report of the Stevens Commis- 
sion, published in The Neurological Journal, 1889. 



of special Senses. 57 

pressed the drum slightly forward at that point. This is 
the end of the bone, the malleus, that conveys the vibra- 
tions back to the internal ear. In most cases a gray streak 
can be seen extending upward and forward, which is the 
body of the bone. Sometimes the drum will appear bulg- 
ing and convex, from the pressure of serum within, and 
the vibrations of the drum are prevented, with resulting 
deafness. Again the drum may appear cupped or concave 
from the stoppage of the eustachian tube and the subse- 
quent absorption of air in the middle ear, so that the drum 
is pushed in by the atmospheric pressure. This is by far 
the more common condition and only impairment of hear- 
ing results until the case is of long standing, when com- 
plete deafness may ensue. Openings in the drum are of 
frequent occurrence as the result of inflammatory exuda- 
tion bursting through from the inside, or traumatic punc- 
ture that has been uncared for. A puncture may not im- 
pair the hearing to any serious extent. Suppuration of the 
ear in any part should be the subject of surgical treatment 
at once, without regard to the whims or prejudices of the 
person possessing an otorrhoea. The discharge is often 
looked upon as a necessary aflfiiction, and relief from other 
woes, but in reality it is a source of debility and impairment 
of health to the person himself, and a nuisance to others. 
Cases of impaction require treatment, and the same may 
be said of the convex drum. The concave drum may be 
due to catarrh, and if so, that should be treated. 

In this connection it may be well to speak of nasal 
catarrh and its influence on health. The disease may be 
considered as a condition of mal-niitrition of the part 
affected, due to irritation of the trophic nerves. It may 
appear as an inflammation of the upper air passages with 
an increased secretion of mucous fluid ; or there may be 
atrophy of the mucous surfaces and of the harder tissues 
beneath ; or there may be extensive ulceration, and decom- 
position of secretions. 

The first form is due to the action of irritants on a super- 

5 



jS Personal History and Exainination 

sensitive membrane. The condition can be produced 
almost instantaneously by the inhalation into the nasal 
openings of snuff from pulverized tobacco, acrid fumes, 
dust, etc.; but the hyperaemia is temporary if the irritation 
is not repeated. The changes of the climate and passing 
from a warm to a cold atmosphere suddenly do not give 
the system time for the nice adjustment to environment 
that enables man to live in every climate where food can 
be found. The result is a continued irritation of the 
mucous surfaces of the air passages and a resulting in- 
flammation with thickening of the superficial tissues until 
the normal nutrition of the part is lost, and disease be- 
comes seated. This swelling may close the openings of 
the eustachian tubes, and impaired hearing is the result. 
Treatment is usually successful, and hence the importance 
of examining the nasal chambers if the history discloses 
any suspicion of defect in this locality. The other forms 
of catarrh are often quite as distressing without as favora- 
ble a prognosis, but relief will not be sought in vain. 

The sense of smell in the atrophic and erosive forms of 
catarrh is often entirely lost, and in all cases is deranged. 
This sense may be tested by inhaling odors that are bland 
and unconnected with articles of food as musk, attar of 
roses, etc. 

The olfactory nerve is perhaps more intimately con- 
nected with the brain tissue than any other, being appar- 
ently a prolongation of the brain through the cribriform 
plate to the nasal walls. As many cases of headache are 
due to a bad condition of the surfaces where this nerve is 
spread out we should examine such cases for ulcerations, 
tumors, malformations and displacements that may cause 
occlusion or pressure. 

The sense of taste is closely allied with that of smell but 
is not so important an indication of the condition of the 
organs with which it is connected. It is a sense with great 
capacity for education, as it was the boast of Roman 
epicures that they could tell by the taste of a fish whether 



of special Senses. 5p 

it was caught above the Bridge or below. A taste may be 
acquired for the most nauseating substances. Children 
have been known to cry for cod-liver oil. But while the 
sense of taste is not important in its relation to health, 
the condition of the mouth may well occupy our attention 
in discovering those facts in a man's condition that make 
for health or debility. A clean tongue indicates good 
digestion ; while a coating indicates some abnormal con- 
dition of the stomach, or liver, or pharynx. A cracked 
tongue means dyspepsia. The tonsils should not protrude 
beyond the pillars of the fauces ; the general surface of 
the pharynx should be smooth and of light pink color ; 
the teeth should be sound or filled ; the vocal cords should 
be a light, pinkish yellow ; and the tracheal rings below 
look like white bands, between which pink tissue can be 
faintly discerned. 

The temperature should be taken with the bulb of the 
thermometer placed under the subject's tongue for five 
minutes. This should be a record of 98.4° F. without a 
variation of half a degree. If the temperature is below 
normal note carefully the general conditions and repeat 
the test at some future time. About one or two per cent, 
of cases have a subnormal temperature. The instrument 
should be carefully washed in an antiseptic fluid after 
using and it is well to have a cup of saturated solution of 
boracic acid into which the mouth-piece of spirometers, 
etc., can be placed after taking records with them. 

The tests of urine for albumen and sugar should be 
practiced until the examiner is sure of his ability. The 
simple methods now prepared by leading manufactur- 
ing chemists and druggists leave little except skillful 
manipulation to the examiner. The record should be 
repeated if any abnormality is found and the subject 
placed under the advice of a physician. 

The director of a gymnasium should always recommend 
some other physician to cases needing medical care. 

The following directions are given for testing the re- 



6o Personal History and Examination 

fractive power of the eye and its color sense and also for 
determining the auditory power : 

Procure of any optician two pairs of spectacles, one with convex 
glasses, No. + .75 Dioptric (equal to No. + .48 in the old or English sys- 
tem), and the other with concave glasses. No. + .75 Dioptric. Also 
obtain a copy of Monoyer's test letters (a card of Dr. Dennett's modifi- 
cation of Monoyer's test type may be procured of Meyrowitz Bros., 
opticians, 297 Fourth Ave., New York City), to be hung up at 5 meters 
distance, and a copy of Green's astigmatic lines, in the form of a clock 
face, to be hung up at the same distance. 

Test : — Seat the subject at a distance of five meters from the test 
cards, which should be hung in a good light. Examine each eye sepa- 
rately, keeping the other covered by a card held in front of, but not 
touching it. Never press the fingers against the closed lid. 

There are ten lines of letters on the test card, numbered from .1, .2, .3, 
etc., up to ten loths or i. If now the subject can read the top line, the 
smallest letters on the card, with the right eye (R.E.) alone, his vision 
(V.) is recorded as ten loths or i. (V.R.E.=i). If he sees nothing clearly 
above the fifth line from the bottom, but can read that correctly, then 
V.R.E.=.5. If he cannot read any of the lines, then V.R.E. = .o. (?. e., 
less than one-ioth). Whatever the vision without glasses may prove to 
be, always next put on the convex spectacles and again cover the other 
eye. If now he can still with the right eye see as well or better than 
with no glasses at all, and can read the same line as before, he is 
Hypermetropic (H.) in that eye. For example, if without glasses it was 
found that V.R.E.=.5, and now after adding the convex glass his V. is 
improved to .8, the record would be V.R.E.=.5, + H.=.8. But if the 
vision is neither improved nor made worse by the convex glass, the 
record will be thus : V.R.E.=.5, + H.=.5. If the convex -glass can be 
used at all without decreasing the vision, no further testing with this 
card is needed ; the subject is hypermetropic in that eye. If it is found 
that the vision of the right eye equals i. without glasses, and then the 
addition of the convex glasses blurs the letters, the eye is Emmetropic, 
that is, the vision is normal (V.R.E.=i.). 

If, however, the vision without glasses is less than i., for instance 
only .3, and the convex glasses make even that line more indistinct, 
then put on the concave glasses. If now the vision is improved so that 
a higher line can be read, for instance the eighth from the bottom, the 
eye is Myopic, or "near sighted," and the record will be V.R.E.;=.3, + 
My.=.8. Or again, if the vision without glasses in the left eye is found 
to be .7 and then with the concave glass the top line can be read, the 
record will stand thus: V.R.E. = .7, + My.=i. After testing each eye 
separately, place the record of one above the other, for example thus : 



of special Senses. 6i 

j V.R.E — I. 

< V.L.E.=.6, + My.=.9. 

This completes the testing for simple hypermetropia, myopia and 
emmetropia. 

After testing the eyes as above, if the vision has not yet been made 
perfect in either, leave on the proper correcting glass, the convex if 
there is hypermetropia, or the concave if there is myopia, or use no 
glass if there is neither ; then direct the subject's attention with that 
eye alone, the other being covered, to the card of radiating black lines. 
If he sees one or more of the lines running in any direction clearer or 
blacker than those at right angles to them, he is shown to be astigmatic. 
Either the perpendicular or the horizontal lines usually appear the 
blacker to the astigmatic person. If the previous record was V.R.E.= 
.7 and this defect is found, then it will be V.R.E.=.7, + As. Or if before 
it read : V.L.E.=.3, + My.=.6, and astigmatism is found, it will read, 
V.L.E.=.3, + My.=.6, + As. Astigmatism may exist either alone or in 
combination with My. or H. If alone we might have a record thus : 
V.R.E.^.6, + As.; V.L.E.=.4, + As., or if with hypermetropia thus : 
V.R.E.=.7, + H.=.7, + As.; V.L.E.=.6, + H.=.8, + As. 

To recapitulate, in brief: if it is found that V.R.E.=r, then the R.E. 
is Emmetropic or Hypermetropic. If emmetropic, the convex glass 
will markedly impair the vision ; if hypermetropic it will not. If the 
V.R.E.=.9 or less, then the R.E. is either h)^permetropic, myopic, astig- 
matic or amblyopic. 

\st. If it is H. the convex glass will not greatly impair the vision. 

2nd. If it is My, the concave glass will improve V. 

"ird. If it is As. one of the radiating lines is blackest. 

a^th. If neither of these defects exists and the V. is less than .7 then 
Amblyopia or partial blindness may be recorded. It may read thus : 
V.L.E.=.6, + Am. 

Caution. — Always try the convex glass. Never try the concave unless 
the convex glass blurs the vision. 

In the following cases the subject should be recommended to consult 
an oculist concerning the advisability of wearing glasses : If the vision 
without any glasses is less than .4 in either or both eyes ; if he com- 
plains of weak, watery or painful eyes, especially in reading, and any 
degree of hypermetropia or astigmatism is found to exist. 

Directions for Testing the Color Sense, 
A reliable set of test worsteds of different colors may be procured 
for $1.25 of N. D. Whitney, 129 Tremont street, Boston. Among these 
will be found three large test skeins colored light green, purple (pink 
or rose), and bright red. To make the examination, spread all the 
worsteds out on a white cloth placed upon a table. First lay the green 



62 Personal History mid Examination 

test skein a little to one side of the others, and then tell the subject to 
throw out of the pile and lay along side of the test skein all the lighter 
and darker shades of that color, or all the skeins containing a shade of 
that color in any degree. Avoid naming the color "green " to him. If 
he throws out only shades of green or light blues his color sense is 
normal (C.S.N.) and the test is completed. But if in addition he throws 
out light grays, or any other shade of gra}', or light yellows, salmons, or 
pinks, he is color-blind. If he handles or fumbles over those shades 
a good deal and hesitates, as if in doubt about them, but yet does not 
throw them out, he probably has " feeble color sense " (C.S.F.). The 
examiner in these cases must use his judgment in making a certain 
amount of allowance for the stupidity of some persons in understand- 
ing what is wanted, especially in the young and uneducated. 

If the subject is found to be color-blind, next la)^ down the purple or 
rose-colored test skein, in place of the green, in order to determine the 
nature of the defect. Now tell him to throw out all the different shades 
of that color. If he only throws out pinks and light reds and shades 
approaching these he is only partly color-blind. (P.C.B.) But if he 
throws out decidedly bluish purples, blues, violets, greens, or grays, he 
is completely color-blind. (C.C.B.) Completely red blind if he throws 
out the blues, violets, etc., or green blind if the grays or greens. 

No further testing is needed, but as a matter of curiosity and to prove 
the result, the red test skein may next be tried in the same way. If he 
matches with it browns or greens and grays he is completely color- 
blind. Dark brown or green if red blind, and light brown or green if 
green blind. 

It is not important to record whether the complete color-blindness is 
red or green blindness. The following classes may be recorded : — 
Color sense normal=C.S.N.; Color sense feeble=C.S.F. ; Partial color- 
blindness=P.C.B. ; Complete color-blindness=C.C.B. 

Color-blind individuals should be warned against engaging in any 
occupation where this defect would prove dangerous or inconvenient. 

Directions for Testing the Auditory Sense. 
Use an ordinary watch and a tuning fork, letter A. or C, as tests. 
Seat the subject with his right side toward you, and then while the 
room is perfectly quiet, see how far off he can hear the watch tick. 
Having previousl)' learned by a few experiments what is the furthest 
distance at which the tick can be heard by normal ears, make that num- 
ber of inches the denominator of a fraction, and the hearing distance of 
each person examined thereafter the numerator. Having found the 
normal distance (=H.D.) to be, for instance, about sixty inches, and 
that of the subject now examined to be, say forty inches, his record for 
the right ear would then be : H.D.R.E.=t^. If it had been f& or i, the 



of special Senses. . 6j 

ear would be normal, f^ would show an abnormally acute sense of 
hearing. If the watch could only be heard while in contact with his 
ear, it would be recorded: H.D.R.E. = ^g. If not heard at all, then 
H.D.R.E.=^-^ Next test the left ear in the same way. Voice sounds 
in talking will often be easily heard by persons quite deaf to the watch 
tick, so that the latter is not always a reliable practical test. 

Suppose we have found H.D.R.E.=f§, H.D.L.E.=i, this implies 
some deafness in the right ear, and the tuning fork will now help us to 
decide whether the cause lies in some defect of the auditory nerve or 
internal ear, or in the external or middle ear or Eustachian tube. Strike 
the fork against some solid substance, and then place the end of the 
handle against or between the subject's front teeth. If both ears are 
normal he will probably seem to hear the ringing of the fork equally 
well in both ears. But if there is a defect in one ear he will either 
seem to hear it louder or more feebly in the affected ear. If, as in the 
case we are examining, the fork is heard best in the deaf ear, this tells us 
that the deafness is due to some defect in the more external parts of 
the organ, and it can probably be corrected by appropriate treatment. 
But if it is heard best in the good ear, it goes to prove that the defect in 
the other ear is more deeply seated and cannot probably be greatly 
benefited by treatment. This effect of the tuning fork is contrary to 
what would ordinarily be expected, and it is often a matter of surprise 
to a deaf person to find that he hears with his teeth apparently better 
on the deaf side. 

We may now add to our record in this case : T.F. best R.E. If it had 
been heard equally well in both ears we would record : T.F.=N. (or 
normal). Where the defect in hearing is at all marked a specialist in 
ear diseases should be consulted. 

Our record in a normal case might be thus : H.D.R.E.=i, H.D.L.E.= 
I., T.F.=N. ; or in an abnormal case it might be thus: H.D.R.E.^i., 
H.D.L.E.=^, T.F. best in R.E. This would imply that the subject was 
so deaf in the left ear as not to be able to hear the watch tick at all, and 
the fork held between the teeth could be heard best in the good ear, 
consequently his trouble is probably seated in the deeper structures of 
the ear, or in the nerve itself, and treatment would not be expected to 
help him greatly. The tuning fork need not be tried unless the watch 
tick shows some defect in hearing. 



CHAPTER V. 

EXAMINATION BY INSPECTION AND PALPATION. 

After the measurements of a person have been taken, the 
work of examination and physical diagnosis should begin. 
The measurement is mechanical and could be done cor- 
rectly by any person, after a little practice ; but a physical 
examination requires the highest product of scientific train- 
ing backed by sound judgment in order to discover the 
true condition of organs and determine the real cause of 
the disordered function or disturbed growth. It may re- 
quire only a mechanical eye to discover a curved spine, 
but it must be the mechanical eye, backed by a thorough 
knowledge of physiology and anatomy, that can discern the 
fact and the cause. 

The suggestion of remedial agents again pre-supposes a 
knowledge of therapeutics, and this field is as broad as sur- 
gery, which rests on a knowledge of the same sciences. 
The therapeutic side of gymnastics has been more thor- 
oughly worked out by the Swedes, who, following in the 
footsteps of Ling, have studied exercise, both active and 
passive, from a medical standpoint, and have developed a 
system of gymnastics that has been approved and applied 
by medical men all over the civilized world. Massage as 
one part of this system is applied in a rudimentary way to 
a great variety of cases in this country, but with the best 
success only by practitioners of foreign education. There 
is a call then for the most extensive preparation in this 
field of work, and in no line of medical practice is there as 
broad a field for original scientific research as in this, the 
prescription of exercise. The following technique is re- 
commended to all those who are making a physical exam- 
ination : 



Examination by Inspection and Palpation. 65 

I. — Inspection should be made with the subject entirely 
nude and standing easily. If a military attitude is assumed, 
try to get relaxation into the ordinary positions. This can 
often be done by calling the attention to some trivial matter, 
as any peculiarity of the hands or feet, or by having the 
subject step forward or backward a few steps, when he will 
forget his strained position. From the front notice (i) the 
general contour or relative breadth, (2) the position of the 
head, (3) the position of the shoulders and arms, (4) the 
curves of the trunk, (5) the muscular condition of chest, 
abdomen, and legs, (6) any malformation, such as tumors, 
cicatrices, etc. 

From the side notice (7) the antero-posterior or normal 
spinal curves, (8) the depth and mobility of the chest and 
abdomen, (9) the position of the shoulders, (10) the relation 
of the hips to the loins, (11) the relation of the neck to the 
trunk, (12) the general attitude of the subject. 

From the rear notice (13) any lateral or spiral curvature 
of the spine and prominence of spinous processes, (14) the 
condition of the shoulder and scapulae, (15) the waist curves, 
(16) any tipping of the iliac crests due to one short leg or 
imperfect bone development, (17) the outline and position 
of the legs and indications of varicose veins and cyanosis, 
(18) the muscular condition, (19) the condition of the skin, 
and (20) any tumor or malformation. 

Of course the examiner will not look up each one of 
these points in regular order, but he should study each one 
and after an examination go over the list and see how many 
points there are on which he has no clear, definite knowl- 
edge, and then try on the next case to make the list smaller 
until he will take in everything at a glance, as it were. 
There are many other matters to which attention might be 
called, but they are mostly amplifications of the above 
list. 

We include in (i) the breadth of head as giving some 
idea of the temperament and vitality of the subject. A broad 
head at the base is believed to indicate a greater vitality 



66 Examination by Inspection and Palpation. 

than is found when the head is long and "top-heavy." There 
is greater power of resisting disease and less liability to 
nervous irritability of a pathological character. A thin, 
weak neck means a bad curve forward at the cervical por- 
tion of the spine, and a consequent fiat chest in a large ma- 
jority of the cases. The voice will be uncertain and the 
throat suffer from catarrhal diseases on the slightest provo- 
cation. 

Narrow shoulders mean compression of the upper part 
of the thorax, and less activity of respiration in the apices 
of the lungs. This, with a history of tuberculosis is unfor- 
tunate, because tubercular degeneration usually begins at 
the apex of the lungs and an inactive part is an unhealthy 
part. This fact has led Dr. T. J. Mays to claim in an ar- 
ticle published in the " Therapeutic Gazette," May, 1887,* 
that the wearing of corsets by ladies may be a protection 
against phthisis, because by compressing the abdomeA and 
lower part of the thorax costal breathing with a freer use 
of the apex of the lung was necessitated and a consequent 
immunity from tubercular degeneration was the result. 
The fallacy of this theory has been repeatedly shown but 
by no one so completely demonstrated as by Dr. J. H. Kel- 
logg of Battle Creek, Mich., whose investigations regarding 
normal respiration are complete and original. f 

The breadth of chest is one of the three factors in making 
up the " Vital Capacity," and its relation to the breadth of 
waist and hips will give a better idea of the natural strength 
than the size of the biceps. Any depression of the ribs or 
sternum should be noted. I have seen a case of severe 
hepatic disturbance that had resisted medical treatment for 
many months, recover more than ordinary health under a 
series of exercises that tended to lift two depressed ribs 
over the liver into a more arched and natural position. 

Notice any elevation of the chest wall in the cardiac re- 
gion, and any transverse depression at about the sixth rib. 

*See " Med. News," Nov. 27, 1886. 

f Transactions of the Mich. State Med. Society, 1888. 



Examination by Inspection and Palpation. 6y 

The elevation may be due to enlargement of the heart or 
pericardiac effusion. The depression is due to faulty habits 
of sitting — the person sliding forward in his chair and sit- 
ting on the sacrum, instead of on the buttocks. This de- 
pression causes a pressure on the heart and interferes with 
the circulation and also causes indigestion quicker than 
plum pudding by restraining the muscular activity of the 
stomach wich is very marked during digestion. 

Under (2) we should note any position of the head that 
might denote a shortness of the sternomastoid muscles. A 
shortness on one side tends to tip the head toward that side 
and turn the face to the other ; if both muscles are short 
they tend to draw the neck forward and tip the face up. A 
narrow thin neck indicates, generally, poor respiratory 
power and a catarrhal throat with laryngeal sensitiveness, 
especially if in (7) we find the cervical curve very deep, or 
the neck slanting forward because of poor support from 
weak muscles. A strong neck is very desirable. It not 
only holds important organs in place and insures good 
circulation in the brain by making the channels direct but 
it gives an aggressive carriage, and indicates determination 
and pluck. In (3) we observe the slope of the shoulders 
and the relation of the acromions to the sternum. If a line 
be drawn from the acromion tip to the base of the neck, 
and continued to the spine, it will make an angle with the 
line of the spine which should approximate to 80°. If the 
muscles that support the shoulder be weak, they permit the 
acromial tips to sink, making the angle less, while if these 
muscles be over-developed they draw the tips up and give 
a stiff hunched appearance that is ungraceful. If the 
muscles in front be better developed than those behind, the 
shoulder will be drawn forward and down, giving an ap- 
parently fiat chest with sloping shoulders, which is a mark 
of slack habits and lack of all exercise of a vigorous char- 
acter. When you get hold of such cases you will feel like 
taking them by the shoulders and, after giving them a vio- 
lent shaking, telling them to " brace up." The effect of 



6S Exafnination by Inspection and Palpation. 

this posture on respiration will be evident to every person 
with a knowledge of the elements of anatomy. The per- 
son has no energy or " sand " because his blood is not 
properly aerated. The arms hang forward, giving the 
feeble, helpless attitude assigned by caricaturists to the in- 
nocent " dude." 

By (4) we mean the outline curves of the waist, which 
show something of the strength of trunk that may be ex- 
pected, and the outlines of muscles that give the beautiful 
curves seen on the athlete. These lines may not be clearly 
cut in some cases of well developed muscles on account of 
the adipose tissues immediately under the skin. This last 
point will help us in estimating muscular condition (5) 
which can not be judged altogether by size. 

It is well to remember that, in (6), we must not only de- 
cide as to the character of the malformation but know what 
the prognosis or probable development will be — what inter- 
ference with exercise will be caused and what exercises are 
contra-indicated — what will be the influence on health — 
what does it indicate as to the physical stamina or consti- 
tutional strength. For instance, varicose veins may never 
have given any trouble and may never have been noticed. 
How long could this condition exist unnoticed and what 
may be expected from it now ? What exercises should be 
avoided, etc., etc. ? In surgery the word tumor means any 
abnormal enlargement of an organ or tissue. 

Perhaps the most frequent form of tumor that will be 
found is due to rupture or hernia. A hernia is a tumor 
caused by the passage of a portion of an organ through the 
bony muscular or tendinous wall that normally confines it. 
It may be produced suddenly by a severe strain or bruise, 
or it may be the result of a gradual distension of one of 
the natural openings of the wall. Cases of intestinal her- 
nia are frequently found, and among young men will affect 
two or three per cent, of all, while among those past mid- 
dle life it will affect as high as six per cent. Among fe- 
males it is much less frequent. This is due to the less 



Examination by- Inspection and Palpation. 6g 

patulous inguinal openings in the female and to less ex- 
posure in the daily avocations of life. Abdominal hernias 
are classed as inguinal, femoral, umbilical, diaphragmatic, 
etc., according to the place where the viscus forces its way 
from its natural support. 

An inguinal hernia may appear at the external inguinal 
ring as a round tumor of greater or less extent and is then 
called " direct," while if it appears first at the internal ring 
and passes down the canal it is called " oblique." The lat- 
ter form is much more frequent and tends to develop rap- 
idly downward, giving the tumor an elongated form with 
higher origin than the direct. 

In femoral or crural hernia the intestine passes down 
through the crural ring under Pouparts' ligament where it 
causes a protrusion of the anterior wall in a round tumor 
that lies in the groin just below the fold at the saphenous 
opening. It is situated farther externally from the median 
line than the direct inguinal and if large will have its axis 
in a horizontal rather than a perpendicular direction. 

These three forms of tumor must be readily differentiated 
from cystic tumors, varices, glandular enlargements, etc. 

Cysts have a well-marked fluctuation. Varices have fixed 
relations to the venous trunks and subside on the subject 
assuming a horizontal position and fill again on rising if 
the inguinal rings are supported. Glandular swellings are 
due to some attendant local irritation and are painful and 
unyielding to pressure. 

The antero-posterior curves of the spine (7) are a con- 
cavity in the cervical and lumbar regions and a convexity 
in the dorsal and pelvic. These curves may all be exag- 
gerated by disease or occupation or muscular development. 
Any increase in the curves must shorten the total height. 
Any weakness of muscles at the back of the neck will per- 
mit the head to hang forward, thus increasing the dorsal 
convexity, producing round shoulders, or kyphosis. An 
over- development of the lumbar muscles as compared with 
those of the abdomen will increase the lumbar concavity, 
causing lordosis. The strong back is the straight back. 



'JO Exaininatio?i by Inspection and Palpation. 

The gymnastic treatment of lordosis, or abnormal an- 
terior curvature, is the only satisfactory one where there is 
no caries or breaking dowa of bone. The same is true of 
kyphosis, of which Dr. Stedman writes for The Reference 
Handbook : " A cure of adolescent kyphosis, when of 
slight degree, may be obtained by exercise alone, without 
mechanical support ; but it will be found advantageous to 
aid the patient in maintaining an erect posture by suitable 
apparatus. — The treatment by exercises in this form of 
kyphosis should never be omitted, since the fault lies chiefly 
in a want of tonicity of the muscular and ligamentous 
tissues." 

If there is exaggerated curve at any part of the spine, 
there will be more or less compensatory curve in the oppo- 
site direction at other parts ; and, in prescribing exercise, 
great care must be used in deciding which is the primary 
and which the compensatory curve, for an error would 
make matters worse from the development of parts already 
strong, and the neglect of parts that are weak. 

In observing the depth of chest and abdomen, (8) and the 
movement of each under respiration we have a clue to the 
activity of the person. If the chest is deep at the sixth rib, 
but thin at the second, the sternum will usually be found 
unsupported by the muscles of the neck ; those behind be- 
ing weak and letting the spine slope forward at the upper 
part so that the sterno-mastoid and the scaleni muscles can 
not raise the chest. This throws all the work of respira- 
tion on the diaphragm, and the person is unfitted for any 
athletic exercise, and would have a cramp in his side if he 
were to run an eighth of a mile. It is said that a round 
chest of equal girth with a flat one will not show as great 
a lung capacity on the spirometer, but my experience does 
not corroborate the statement. 

If the abdomen protrudes, or sags, so that the intestines 
seem to be held just above the pubic arch, especially if 
there be a history of hernia, or excessive corpulence, or 
indigestion, the matter is of such import as to call for thor- 
ough instruction and earnest advice. Much discomfort, 



Examination by Inspection and Palpation. Ji 

ill-health, and physical suffering will be saved such cases, 
if the abdominal muscles be developed by persistent exer- 
cise — the abdominal cavity contains quite as important or- 
gans of health as the thorax, and the competent instructor 
will not spend all his time and talk on the chest. 

In (9), (10), (11), (12), we have some of the points that go 
to make up the carriage or general appearance of the sub- 
ject, and they constitute the difference in physique between 
a West Point cadet and a slouching loafer. 

Our rear view of the subject will disclose any lateral 
curvatures (13) of the spine, or scoliosis, and we should not 
only see any deformity of this character but should be able 
to judge of its nature, and determine its causation. The 
curve may be simple and confined to one part of the spine, 
or it may be multiple. In the latter case one of the curves 
is usually the primary lesion, and the others compensatory. 
The reason for the compensatory curve is found in the 
natural effort to maintain an erect carriage. If there be a 
slight curvature to the left in the lumbar region, it would 
tend to tip the shoulders to the right but the natural effort 
to straighten the spine has most success where the muscle 
is stronger and not at the point of greatest weakness, to- 
ward which the convexity lies. The result is the bending 
of the upper part into such a position that the weight is in 
equilibrium, and the shoulders fairly level. This effort to 
bend a higher portion of the spine to produce a balance of 
weight usually is the cause of a slighter curve higher up in 
the cervical portion, that restores the head to the erect 
position. This gives a curve to the left, in lumbar region, 
another higher up to the right, in dorsal region, and an- 
other still higher to the left in the cervical portion of the 
spine. If this explanation is correct it is plain that the pre- 
disposing cause of scoliosis must be due, in a large majority 
of the cases, to the weakness or uneven development of the 
muscles and ligaments that support the spine. If the mus- 
cular strength and activity of one side be greatly in excess 
of that of the other, the spine must of necessity be drawn to 
that side which will throw the convexity toward the weak- 



^2 Examination by Inspection and Palpation. 

ness. If this principle obtains in all the anatomical relations 
— and its influence can not be denied — no better argument 
could be used in favor of training for bilateral symmetry. 

The fact that girls are affected by spinal curvature more 
often than boys (the proportion being 4 to i) would seem 
to indicate a need of more robust exercise out of doors or 
in gymnasiums that shall give a development of the erector- 
spinae mass and all the muscles above the hips that shall 
compare favorably with that of boys. The influence of 
corsets and stays has been repeatedly shown to be the cause 
of great muscular debility in the parts constricted, and all 
medical authorities assign a large part of responsibility for 
curvatures to their use. The lumbar muscles of the female 
have a comparatively larger field of origin at the pelvis 
and should be correspondingly strong, but under the dif- 
ferentiation of civilization and the corset, the female waist 
has degenerated into a backache. 

Pressure on a muscle tends to drive the blood out, and 
if it be continuous, the circulation is impaired. This con- 
dition means bad nutrition of the muscle, and that leads to 
imperfect development or to actual atrophy. Is it any 
wonder then that a physician hears from his female clients 
one long complaint of weak backs, back-aches and general 
debility ! 

The remedial exercises for curvatures need only be sug- 
gested here, as the only treatment, is forcible straightening 
and proper exercises. The care should be exercised on the 
weakest spot, which, in some way, " must stand the strain." 
Suspension, as on the rings and bars, and the direct exer- 
cise, either active or passive, of the degenerate muscle, is 
the general plan of treatment. 

The prominence of the spinous processes are of diagnos- 
tic value in locating weak spots. If the interspinous liga- 
ments have been strained and stretched by lack of muscu- 
lar support or bad habits of posture, as sitting back on the 
hips, and letting the weight of the trunk press the lumbar 
vertebrae back, or a pernicious habit of letting the head 
hang forward, the saw-toothed appearance of the spine, as 



Examination by Inspectio7i and Palpation. yj 

the subject bends well over, will disclose the fact. Notice 
the alignment of these processes as the subject is bent 
over, and straightens up. A failure of one or two, here 
and there, to stand in the line, is not an indication of dis- 
ease, but is due to a slight bend in the process, as will be 
seen on examining almost any skeleton. The spinal curva- 
ture will be indicated by a number of them assuming a 
general curved outline. 

The mobility of the scapulae (14) varies greatly in differ- 
ent people. A more beautiful contour exists when the 
trapezius and rhomboidei are strong and short holding the 
scapulae down and well back to the spine, but the range 
of arm movement is not so great. A good development 
of these muscles is very desirable as they prevent the 
shoulders from rolling forward and flattening the chest. 

In (15) notice the size of the lumbar muscles, with the 
subject bent over. 

It should be borne in mind that a shortness of one (16) 
leg is comparatively frequent, and this deficiency causes 
the pelvis to tip with resulting spinal curvature. Distocia, 
or deformity of the pelvis may have the same effect. 

The bone of the legs (17) can not be greatly changed by 
exercise, but something can be done in early life to relieve 
one of the burden of bow legs or knock-knees. Therefore, 
in the examination of children, do not overlook this point ; 
nor needlessly turn the attention of the subject to it when 
there is no relief, but occupy his mind with matters that 
can be improved and modified. In observing the legs, 
notice any cyanosis about the ankles, and varicose condi- 
tion of the veins, especially of the lower leg. In some 
persons the skin is firm and seems to fit the underlying 
tissues very closely, thus giving support to the venous 
walls ; while in other cases the skin is relaxed and thin, 
furnishing poor support to the superficial vessels. If we 
recall the fact that the hydrostatic pressure alone in a 
person of ordinary height, while standing, would be a 
trifle over two lbs. in the vessels of the foot, and that the 
friction of the current along the vessel wall, the impedi- 



7^ Enamination by Inspection and Palpation. 

ment from constriction of clothing and speed of the 
current, all add to this pressure we can readily see why 
certain classes of people are specially liable to dilation of 
the veins, and suffer accordingly. Persons obliged to 
stand much of the time without great change of position 
(as clerks, book-keepers, bench mechanics, etc.), and very 
fat people, who stand a considerable part of the time, are 
most often affected. The pressure on the external iliac 
vein in corpulent people is a predisposing cause, as it pre- 
vents the free return of the blood into the trunk ; and the 
same may be said of garters, tight clothing on the thighs, 
or elastic thigh bands, tight belts around the waist, corsets, 
and any garment or device that prevents normal respira- 
tion. ■ (See illustrations, Chap. IX.) The proper advice in 
these cases is clear. Restriction should be placed on all 
exercises like jumping where the feet strike the ground 
hard ; running on pavement, floors, etc.; bicycle riding, 
because of the pressure of the saddle on the femoral and 
saphenous veins ; violent exercises, like foot ball, etc., etc. 
Light exercise should be encouraged, for, the better the 
tone of the tissues, the less giving way will there be to 
pressure. Exercise of the skin to keep it healthy and firm 
— such as massage and cold water baths, to stimulate the 
contraction of the tissues — will be of assistance. In this 
condition, "forewarned is forearmed." Cyanosis is a 
varicose condition of capillary veins and indicates poor 
circulation. In cyanosis about the trunk search carefully 
for some heart lesion. 

The condition of the skin (19) will signify much to the 
careful examiner. Not that every subject with acne should 
be set down as dyspeptic, but in an almost intuitive way 
the careful observer will learn to diagnose many internal 
ailments and judge of vices that might otherwise be un- 
known. There is something that can not be described in 
the healthy, firm, velvety skin of an athlete. It must not 
only be seen, but felt, in order to be appreciated. It is 
better to be rolled in the dust by a hearty, healthy wrestler 
than to shake the flabby, moist hand that is placed in 



Exafnination by Inspection and Palpation. 



75 



yours by some advocate of moral suasion and intellectual 
top-heaviness. The skin, like the eye, is the mirror of the 
bodily health, if we only know how to see the image 
clearly. Its firmness, its elasticity, its smoothness, its 
moisture, its odor, its color, its warmth, all are full of 
meaning. Physicians often read the complaint in the 
countenance of the patient, before his mouth has uttered 
it. We have in observation not only the facial coun- 
tenance but the expression of the whole body. How much, 
then, should we rightly judge of the inner man ! The 
delicate tint seen on the skin of the woman who has exer- 
cised in the open air, until every tissue proclaims her the 
type of health, is as superior to the rusty covering of the 
dyspeptic house plant, as that is superior to the hide of a 
pachyderm. Local diseases may deform the skin, but the 
indications of general health will be found, if it exists. 

The following table will present in compact form some 
of the more prominent points observed by inspection : 



GENERAL ASPECT. 



Aspect of chest. 



Front View. - 



(i) Form. -{ 



waist. 



legs. 



f Flat. 
I Round. 

\ Bilateral asymmetry. 
I Sternum depressed. 
1^ Pectoral muscles. 

j Breadth. 
( Muscles. 

Bow-legs. 

Knock-knees. 

Muscles. 



Side View. 



Rear View. ^ 



" " neck. I y 

Poise of head. 
" " thorax. 
" " loins and belly. 
" " hips. 

f Neck. 
j Shoulders. 
Waist. 
Hips. 
Height of acromions. 
Line of spinous processes. 
Scapulae. 
Pelvic crests. 



Sterno-mastoid. 
ateral muscles. 



Breadth. 



^6 Examijiation by Inspection and Palpation. 

' Undulythin. | g^StV'"" \^'^-^^^- 



(2) Nutrition. ^ 



(3) The Skin. - 



i Evenly distributed and firm. 
Unevenly " and soft. 
Fatty degeneration. 

Acne, furuncles, etc. 

Eczema. 

Psoriasis. 

T-^,,^^.^ ^ J ( Circinatus. 

ii-ruptions. -< rp. ) TT • 1 

^ I iinea. •< Versicolor. 

( Tricophytosis cruris, 

I Ulcerations. 

1^ Erysipelas. 



Cicatrices. < 



{ Bruises. 

Traumatisms. \ ^"^"s. 
I Cuts. 
[ Lacerations. 
Carbuncles, variola, etc. 
Free. 
Bone. 



Abscesses. 



Tumors. ■{ 



i Comedones. 
Seborrhoea. 
Sebaceous cysts. 
^ Ichthyosis. 
Hypertrophy. \ Goitre. 

( Condylomata, callus, etc. 
r Chicken breast. 
Malformation. X Retained testis. 

( Funnel chest, etc. 
Varicocele. 
Cysts. \ Hydrocele. 
Abscess. 



Lentigo. 

Chloasma. 

Jaundice. 

Discolorations. \ Erythema. 

Purpura. 

C)''anosis. 

Bruises. 



CHAPTER VI. 



PALPATION. 



The use of the sense of touch, or palpation, is of great 
importance in locating tumors and determining chest 
movements, viz : frequency of respiration, vocal fremitus, 
ronchi, frictions, etc. By the eye you can only imperfectly 
judge of size and consistency. An arm may be large, but, 
if soft and flabby, it does not indicate health or strength ; 
while if it meets our hand with a proper resistance — not 
too hard nor too soft — we know that it is capable of good 
things, be it large or small. Palpation enables us to say 
how much fatty tissue underlies the skin, and how firm the 
muscle is under the fat. It is a mistake to set every person 
with abundant adipose tissue in the list of " muscles unde- 
veloped." Nor is fat a substance of no worth to the 
physical economy and to be avoided. In certain quanti- 
ties it is of the greatest advantage to health, and is an 
indication of high nutrition. It is so much physiological 
capital stored up, and is so located as to prevent loss of 
heat by radiation, especially over the more sensitive organs, 
and therefore saves the energy that would be lost in heat. 
This is nature's way of protecting her children from the 
increased severities of the season ; for, as autumn brings 
presages of winter by her cooler nights, every animal, in 
health, grows fat, and those that are exposed to. continued 
low temperatures, like whales, seals, bears, etc., lay up 
enormous stores of it underneath the skin, where it will do 
the most good, and over the abdominal organs and heart. 
If the supply of food is cut off, the fat is consumed to pro- 
vide vital force for long periods of time. The same is true 
of man, but to a less extent. As civilization has relieved 



y8 Palpation. 

him of many of the exigencies of nature, it has modified 
his requirements, restricting them in some directions, and 
enlarging them in others. The modern civilized man 
needs less fat than the Esquimaux, because he has a milder 
climate and better facilities for heating his house, but he 
needs some fat to prevent the irritation of the nervous 
tissues from the adjustments of heat production that are 
so rapid in a well-balanced body, when we pass from a 
cold to a warm atmosphere, and the reverse. This strain 
is thrown on the involuntary or sympathetic nervous sys- 
tem, and this is the part that breaks down in the so-called 
" nervous prostration," or " neurasthenia," which is so 
common. Not that lack of fat stands in causative relation 
to this disease, but that one source of strain is found here. 
Such persons bear the cold badly and seek warmth ; their 
treatment is warmth and nutrition. The argument, then, 
is that a fair amount of fat is conducive to health of the 
nervous system. The same may be said of all the other 
organs. The lean man has no extra physiological resource 
to fall back upon, if irregularities are forced upon him, 
either in the way of lessened food supply, or sleep, or 
greater demand on his energy, either physical or mental, 
and his comfort and health soon suffer. 

By palpation we may also judge of the temperature and 
moisture of the skin, and thus estimate its activity in ex- 
cretion. A healthy skin should be firm and velvety, even 
in texture and activity, slightly moist under ordinary cir- 
cumstances but not wet, colored a delicate shade of pink, 
without being flushed or having dilated capillary vessels, 
as will be found common in the clavicular or scapular 
region. If the skin is hot and flushed, it indicates the 
presence of fever, or a local disturbance of circulation, due 
to deranged nerve activity. If the skin be dry, and tends 
to form scales, the superficial circulation is insufficient, 
and bad digestion is a common accompaniment. Free 
exercise, shower bathing, massage and friction will set 
things to rights if persistently employed, unless the skin 



Palpation. yg 

be affected by ichthyosis, which " is a congenital, chronic, 
hypertrophic disease," and hence will be but little bene- 
fitted. Profuse perspiration is found frequently, and 
seems injurious only in prolonging bronchial inflamma- 
tions and general catarrhal conditions, by keeping the 
clothing damp a large part of the time. There is also an 
increased liability to Bright's disease from high concentra- 
tion of urine and chilling of the surface on slight exposure. 

Hyperidrosis will be favorably influenced by active 
exercise, as the circulatory system will at that time be 
depleted by the free sweating, and will give up less moist- 
ure in a state of rest. After exercise the damp clothes are 
removed, the sweat is washed off in the shower bath, and 
the skin is dried by proper massage, leaving slight liability 
to "colds." Local hyperidrosis may seriously impair the 
health by keeping the feet damp and cold and thus induce 
catarrhal, pneumonic, and rheumatic conditions. Medical 
advice is to be recommended in such cases, if hygienic 
precautions — such as cold baths, frequent change of cloth- 
ing, sensible shoes with cloth tops, proper diet and regular 
exercise — do not avail. At times the under and inner sur- 
faces of the toes and the outside margin of the foot from 
the little toe back to the instep will appear white and 
swollen in these cases. This condition closely resembles 
large blisters from scalds, but is only a water-soaked, 
" parboiled," state of the epidermal layer, like that seen on 
the hands of washer-women after they have been in hot 
soap-suds for a half hour. The advantage of a cloth-top 
shoe in these cases is apparent when we think of the com- 
parative ease with which moisture passes through woolen 
fabrics as compared with difficulty of evaporation through 
leather. 

A condition of anidrosis, or too scanty perspiration is 
frequent without evident impairment of health. The skin 
is apt to get very dry and harsh, especially in cold weather, 
and eczema of the hands result. In many of these cases 
there is no general sweating, even in extremely hot weather, 
and perspiration is not copious. 



8o Palpation. 

It may be well to explain that " perspiration " is the 
term applied to the insensible exudation from the sweat 
glands that is evaporated as fast as secreted, while " sweat- 
ing " is the appreciable collection of this exudation in 
drops of greater or less abundance. (See Foster's Physi- 
ology). 

In addition to what we learn of the integument and 
muscle by palpation, we detect by it certain movements 
that characterize health or disease. If we place the hands 
firmly on the walls of the chest, letting the fingers press 
the intercostal regions, there will be felt a movement of 
the chest on each inspiration and expiration, if respiration 
be normal. Any failure in expansion is noticed if there 
be interference with the chest action, from muscular or 
mechanical cause, that is unilateral. There should be 
bilateral symmetry of movement, but this may be hindered 
by muscular soreness from rheumatism, neuralgia, traumat- 
ism, etc.; paresis of a muscle, or group of muscles ; intra- 
pleural effusions ; new growths ; or by solidification of the 
lung or any considerable part of it. Malformations may 
also interfere with bilateral symmetry of movement. 

If the subject be asked to repeat some word such as 
" ninety-nine," or to count aloud, one, two, three, while 
the hands are on the chest, as above described, a peculiar 
vibration will be felt, which is known as the " vocal 
fremitus." This thrill, or vibration, is much more promi- 
nent in persons with thin chest walls and low pitched 
voices, than where the wall is thickly padded with fat, and 
the voice in high key, on the same principle that the low 
bass strings of a piano, when struck, impart vibration to 
solid articles in the room in an appreciable degree ; while 
the high notes have a less perceptible effect. The " vocal 
fremitus " is somewhat plainer on the right side, on account 
of the larger size of the right bronchial tube. A fremitus 
may be caused by other sources of vibration than the voice, 
as by a cough, by mucous rales, by pleuritic friction, and 
the splashing of liquid, when the chest contains liquid and 
air. 



Palpation. 8i 

The " ronchial fremitus," due to mucous in the bronchial 
tubes, is frequently very marked in bronchitis, and felt by 
the subject himself ; but the area is circumscribed in most 
•cases. The friction fremitus of pleuritic inflammation is 
faint and local in character. In general, those diseases 
that produce solidification of the air cells of the lungs, 
without obstruction of the bronchial tubes, increase the 
vocal fremitus ; while those that interpose more air, like 
emphysema, decrease it. Liquids diminish or check it 
altogether. The scapulae interfere with the fremitus as 
does the liver, the latter not conveying the vibrations, and, 
if pressing firmly against it, preventing the chest wall from 
doing so below the margin of the lung. 

Palpation is of great service in the diagnosis of tumors. 
The fingers are to be placed on one side of the swelling, 
and gentle but firm pressure made on the opposite side of 
it with the fingers of the other hand, by a quick movement 
of the wrist. If the contents of the tumor are liquid a 
bulging will be felt under the fingers, caused by the dis- 
placement of the fluid, that passes as a wave through the 
tumor, distending the sac at one part to accommodate the 
liquid depressed at another. This peculiar wavelike 
motion, called fluctuation, can be well studied by exami- 
nation of a rubber water bag under varied thickness of 
covering, having the bag distended hard, and again with 
less water in it, but no air. In cases of ascites the wave 
impulse is readily felt across the abdominal cavity — a light 
tap with the end of the finger against the side being suffi- 
cient to start the wave. A close estimate of the amount of 
fluid can be formed in this way, as the wave simply con- 
tinues through the liquid part, and is not propagated by 
the intestines or general tissues. 

The apex beat of the heart may also be located by palpa- 
tion in a large majority of cases. In many subjects the 
chest wall is thin, and the heart action strong, so that 
inspection can determine the apex impulse with- tolerable 
precision ; but if it fail to fall in an intercostal space, or 



82 Palpation. 

the chest wall be thick, or the heart -beat feeble, palpation 
must be used. In this connection it may be said, that for 
this purpose the ear may be the organ of tactile, as well as 
of auditory impressions. 

The character of acute or chronic inflammatory action 
can often be determined by palpation, as in swellings 
about joints. 



CHAPTER VII. 

PERCUSSION AND AUSCULTATION. 

The condition of the internal organs is determined in 
several ways. Among the most frequently employed, be- 
cause most satisfactory in results, is by listening to the 
passive and active sounds so far as they can be secured to 
the ear. The passive sounds are obtained by percussion, 
or striking the surface over an organ, either with the tips 
of the fingers or a rubber mallet directly, or by laying a 
solid substance, or the finger, firmly against the surface, 
and striking this. The first method is called immediate 
percussion, and is seldom used, except for hard, bony sur- 
faces. The- second is called mediate percussion, and is 
applicable to all parts. 

The sounds obtained by percussion vary in quality, in- 
tensity and pitch. The quality of the sound obtained over 
the various organs can only be rudely described, but prac- 
tice will give skill in distinguishing it. The intensity will 
vary according to the surrounding medium, and the pitch 
will vary largely through change in the organs that pro- 
duce the sound. 

The region of the body most frequently examined by 
percussion is the thorax. The abdomen, especially in con- 
ditions of disease, is often examined by this method (in 
connection with palpation), but without the satisfactory 
accuracy that is to be secured over the chest, although it 
enables one to distinguish the outline of solid tumors of 
hepatic, splenic or intestinal origin and the area covered 
by cystic enlargements. 

The method of employing percussion is generally with 
the fingers, although, if many examinations are made daily, 



84- Percussion and Auscultation. 

it is well to use a pleximeter and percussor (as shown in cut). 
It seems to the writer that the appreciation of vibrations 
by the finger is of considerable importance in assisting the 
ear, and, therefore, that digital percussion is better than 
instrumental. The act is easily performed by laying the 
fingers of one hand firmly, over the part to be examined, 
and, with the tips of the first two or three fingers of the 
other hand, or the middle finger alone, striking against one 
of the fingers imposed on the part with a firm blow, accom- 
plished by a wrist movement of flexion. The force of the 
blow may be varied to perceive the difference in resonance, 




Fig. 19. 

Showing the normal outlines and positions of the heart, lungs, liver, 
and stomach. The light dotted line shows the outline of the lung at 
inspiration b. d. and at expiration f. h., and also the lobar divisions at 
i. k. 1. The heavy continuous line shows the outline of the liver. 
The light line shows the location and divisions of the heart. The heavy- 
broken line indicates the outline of the stomach. Luschka. 



Percussion and Auscultation. 8^ 

quality, and pitch of the sound under the new conditions, 
as this may have an important bearing on our determina- 
tion of the case. Forcible percussion sets in vibration 
deeper tissues, and, if their condition varies greatly from 
the superficial tissues, there will be a mixed quality to the 
sound that aids in identifying healthy activity, or disease, 
or abnormal position. For instance, if we begin at the 
right clavicle and percuss downward, until we reach the 
lower edge of the liver, we shall pass over lung tissue at 
first where the sound elicited under mild or forcible per- 
cussion is essentially the same ; lower down we reach a 
part of the lung that contains the large bronchial tubes 
when the pitch is lower and resonance good, then still 
lower to a part that is backed by the upper convexity 
of the liver with only the solid diaphragm and lung 
between it and the chest wall. Here under mild per- 
cussion the resonance is unimpaired ; but under a firmer 
stroke the resonance is found to lose its clearness and 
become duller, and this dullness increases as we percuss 
to the very edge of the lung, where the sound is fiat. See 
Fig 20. The term "flat," as applied to percussion sounds, 
is such a quality of tone as is produced when an organ con- 
taining no free gaseous element is set in vibration by an 
impact. The word " dullness " is comparative only and 
denotes less resonance than should be expected under 
normal conditions. 

In using the pleximeter, we press it firmly against the 
surface, and strike upon it with the rubber percussor. The 
resonance of the instrument is slightly confusing to the 
person who has been accustomed only to digital percussion, 
but practice soon enables us to eliminate this sound, as 
one does the sounds of mercantile life while listening to a 
voice in the telephone. Practice alone will give skill in the 
determination of normal or abnormal sounds. It may be 
remembered that for any individual the resonance of the 
chest is fairly constant in health, but that of the abdomen 
varies continually ; again, the resonance of the abdomen 



86 Percussion and Auscultation. 

is always tympanitic or flat, while that of the healthy chest 
is neither. In making a physical examination, percussion 
of the abdomen is useless, unless there be a history of ab- 
dominal disorder, or inspection and palpation indicate 
something abnormal. 

For convenience in describing any location on the anterior 
aspect of the trunk there has been a long-continued custom 
of dividing the body into a right and left half by a median 
perpendicular line and then designating the portion on 
either side above the clavicle as the supraclavicular region, 
right or left. The portion below the clavicle as far down 
as the third rib is called the infraclavicular region and the 
part covered by the clavicle is called the subclavian region. 
The mammary region extends from the third rib to the 
sixth. Below the sixth rib is the inframammary region, 
extending to the margins of the ribs. The lower sternal 
region extends from the ensiform cartilage to the third 
costal cartilage, and from this point to the sternal notch is 
called the upper sternal region. From the top of the ster- 
mine to the cricoid cartilage is the suprasternal region. 
The limits on the right and left are perpendicular lines 
drawn from the tips of the acromions. At the side the 
axillary region extends from the summit of the axilla to 
the sixth rib, and below this is the infra-axillary space, ex- 
tending to the bottom of the chest. 

The abdomen is divided into nine regions for purposes 
of description, as follows : Draw a horizontal line across 
at the level of the narrowest part of the waist and a second 
line at the level of the iliac crests. Draw a perpendicular 
line from the middle of Poupart's ligament, on each side, 
extending up to the chest. On the outside of these lines 
will be found, above, the right and left hypochondriac re- 
gions extending down to the first horizontal line. Between 
the horizontal lines will be the lumbar regions and below 
these the iliac regions bounded by Poupart's ligament. The 
central portion is called the umbilical region. Above this 
is the epigastric and below the hypogastric regions. 



Percussion and Auscultation. 



87 



In examining a subject by percussion it is well to begin 
on the supra-clavicular region and percuss lightly and then 
forcibly on each side, and press the fingers well against the 
intercostal muscle rather than over the ribs, while proceed- 
ing to the lower edge of the chest ; then purcuss the right 
axillary region ; then the posterior thoracic, from top to 
bottom, striking on alternate sides in order to discover any 
difference in sound that may exist, and then the left axil- 
lary space. There should be equal resonance of sound on 
each side behind, unless there be extreme unevenness of 
muscular development, which will slightly dull the sound 
on the strong side ; but in front the location of the heart 




Fig. 20. 
Showing the areas of percussion dullness and flatness over heart, 
liver, and stomach, i. k. line of beginning dullness around the 
heart, a. b. d. c. area of flat sound or without pulmonary resonance. 
p. q. line of dull area over the liver, e. c. m. I. area of flatness over liver. 
m. n. 0. area of varying resonance over the stomach. Weil. 



88 Percussion and A uscultation. 

to the left of the sternum, and the liver to the right of it, 
and lower down gives a wide variation in sound for sim- 
ilar locations on the two sides. On the right we usually 
find the point of liver dullness beginning about 2*=™. be- 
low the nipple, while the line of flatness is about 6^"". 
below it — the flat area extending about the breadth of the 
hand or to the edge of the ribs, and around to the spine. 
See Fig. 20. On the left the area of heart dullness begins 
at about the third intercostal space, near the sternum and 
extends out to a point nearly an inch above the nipple, 
and down for 3*^™., shading off into the flat heart area — that 




Fig. 21. 

Showing the positions of the kidneys, j. k., and spleen, k ; margin 
of liver, /. The dotted line, e. f. g., shows the lobar divisions of the 
lungs. Scheube. 



Percussion and Auscultation. 8g 

is circular above about 5°™. in diameter and having its 
center at a point half way between the nipple and the 
center of the end of the sternum, and reaching down- 
ward to the sixth rib, where it is merged in the stomachic 
resonance. See fig. 20. 

The line of stomach dullness is of variable location and 
may not be perceptible at all. 

The percussion sound of the abdomen is tympanitic or 
flat, according to the existence of gas in the intestinal canal. 
In cases of ascites, a peculiar wave impulse is started by 
immediate percussion that is readily felt by the other hand 
held against the abdominal wall opposite the point of im- 
pact. The same is true of cystic tumors in other locations, 
where the walls are protected only by soft tissues, as in 
effusion into the synovial cavity of the knee and other 
joints, as a result of inflammation or hemorrhage. This 
wave impulse corresponds to the fluctuation of palpation. 
See page 81. 

The area of liver dullness should not extend below the 
lower edge of the ribs, on the right side, while the spleen 
is found well around to the left side, extending from the line 
of dullness at ninth rib, downward about eight cm., the 
breadth being about half this distance. See fig. 21. In 
ordinary cases the spleen is not to be sought, as its func- 
tion is not fully known, and its recognized abnormalities 
are confined to malarial and congestive fevers, with oc- 
casional malignant growths. The length of the thorax will 
be found to vary greatly in different people, and, where the 
ribs come well toward the umbilicus, the liver should hardly 
reach to the lower edge of the ribs, except in front, while 
in the cases of short chest it may extend five or more c. m. 
below the free margin. The left lobe extends across the 
median line for about six or eight c. m., (fig. 19) where its 
limits are not readily discovered by percussion, on account 
of the area of heart dullness. At the right side the liver 
extends down to the tenth intercostal space, and behind it 
reaches to the last rib. See fig. 21. 
7 



po Percussion and Auscultation. 

It should be remembered that the lower limits of the 
liver may vary greatly without its being an indication of 
enlargement or disease. In examining this organ, there- 
fore, it is well, if any apparent malformation exists, to 
determine by percussion, and mark with a flesh pencil the 
outline of the organ. The exact measurements can then 
be made and malposition differentiated from hypertrophy. 

Some of the more common causes of malposition are 
tight lacing, pleuritic effusion, congenital and traumatic 
malformations, pericarditis with effusion, and certain ab- 
dominal tumors. For convenience in treating the normal 
positions of certain organs, the following points should be 
fixed in mind : 

The sternal notch is on a level with the top of the second 
dorsal vertebra or tip of seventh cervical spine. 

The spine of the scapula is on a level with the third dor- 
sal spine. 

The lower angle of the scapula is on a level with the 
seventh dorsal spine. 

The base of the heart lies at the fourth dorsal spine. 

The apex of the heart lies at the level of the eighth dor- 
sal spine. 

The apex of the lung lies opposite the seventh cervical 
spine and vertebra, and from two to four cm. above the top 
of the sternum. 

The base of the lung is on the level of the tenth dorsal 
spine. 

The spleen lies on the level of the ninth and eleventh 
dorsal spines. 

The upper convexity of the liver lies on a level with the 
eighth dorsal spine or slightly above the lower end of the 
sternum. 

The nipple usually covers the fourth intercostal space at 
level of sixth spinous process. 

These locations are all referred to the spinous processes 
of the vertebra as fixed points that can always be found. 
If we rub the ball of the thumb firmly down the furrow 



Percussion and Auscultation. gi 

between the erector spinae muscles, the tips of the spinous 
processes will show as pink spots on the skin. This 
method is recommended by Dr. Holden to determine the 
existence of lateral curvatures. 

In auscultation we have the method of most precise 
knowledge in diagnosis. By other methods of examina- 
tion we may learn that there is something wrong, but the 
ear is the supreme court to decide the case and tell what 
that " something " is. For purposes of auscultation sev- 
eral instruments have been devised, but none better for 
general use than the binaural stethoscope of Dr. Camman 
(see Fig. 8), with its improvements for clasping into the 
ears, without undue pressure. The unassisted ear is able 
to do all that is required in most cases, as the sounds are 
equally distinct, but the ear can not be readily applied to 
all parts of the chest, and to attempt it in some cases would 
be to affect other parts of the sensorium with more pro- 
found salutations. 

The stethoscope also enables us to localize sounds closely 
by making a direct course of travel for sound-waves. Con- 
sequently, it readily transmits those waves that pass directly 
into its bell or tube ; while those waves that are not thrown 
directly in, are either lost or become obscure, so that our 
attention is centered on the sounds produced directly be- 
neath. The pressure of the aural tips closes the external 
meatus of the ear, so that foreign sounds are entirely 
eliminated. 

The following points in the use of the instrument should 
be borne in mind : 

1. Apply the instrument to the ears so that the aural tips 
will point downward and inward, thus following the direc- 
tion of the meatus of the ears. 

2. Have just sufficient pressure in the ears to hold the 
instrument steady and make the tips fit perfectly. 

3. Let no foreign material touch against the stethoscope 
at any part of it during use, as friction-vibrations will be 
set up. 



g2 Percussion and A ttscultation. 

4. Press the bell firmly over the spot to be auscultated, 
so that it fits the integument perfectly all around. If the 
surface is uneven, the soft rubber bell should be used. 

5. Do not let the fingers move on the instrument while 
holding it in place. 

6. Always apply directly to the skin, as nothing satisfac- 
tory can be heard through even a thin layer of cloth. 
(See page 30.) 

7. The examiner should keep his own head as nearly 
erect as possible to avoid cerebral congestion from venous 
constriction. 

"Where the naked ear is used, a soft cloth can be inter- 
posed between it and the subject. 

In listening to the sounds of the mitral and tricuspid 
valves with a stethoscope, it is well, should there be doubt 
in diagnosis, to place a thin cloth, like a napkin, on the 
chest, and auscultate through it. The only sound heard 
through this will be the valvular click — the first sound 
becoming short and uncomplicated like the second sound. 

In auscultation continued practice must be given to 
learning normal sounds and their relations. If the exam- 
iner knows every healthy sound with its variations, he will 
instantly recognize an abnormal one, even if he is not able 
to clearly state or even understand the existing lesion. 
Some sounds are so complicated as to defy experienced 
surgeons in reading their significance. 

The following points are to be studied : 

{a) Muscle-sounds, by placing the stethoscope over a 
muscle like the biceps, during its contraction and relaxa- 
tion. 

{b) Heart-sounds, by studying the sound at each location 
in the precordial region and along the large arteries. 

{c) Lung-sounds, in every region of the chest. 

[d) Intestinal-sounds, that are caused by the gases of 
fermentation. • 

((?) Succussion or splashing sounds of fluid in the stom- 
ach (or chest), while it contains free gas. 



Percussion and A uscidtation. pj 

(/) The " bruit " or hum heard in many cases over the 
large venous trunks, especially of the neck and upper 
chest, and over aneurismal sacs. 

A muscle sound is of low pitch and vibratory quality — a 
rapid throbbing as it were. Its character is represented in 
exaggerated form by moistening the end of the thumb and 
then rubbing it along the surface of a wooden table with a 
fairly rapid movement. The thumb will jump along the 
surface giving a low vibration to the wood. This muscle 
sound is the cause of the peculiar, prolonged, " booming" 
sound of the heart during its contraction, and it modifies 
the valve sound of closing to some extent ; therefore the 
directions on page 30 should be followed if there is an 
apparent systolic murmur. 

The valve sounds are brief in duration, of high pitch and 
clicking or non-resonant quality. These sounds are con- 
fused more or less by the muscle sound, by respiration 
sounds and by the vibrations of blood currents both nor- 
mal and abnormal. These abnormal sounds are generally 
of blowing quality and are called murmurs. They will be 
studied more at length in Chapter VIII. The sounds of 
the normal heart must be patiently studied with the stetho- 
scope until its every peculiarity is familiar ; its rythm, its 
force, its various valve sounds, its points of clearest differ- 
entiation of complex sounds and its transmission of sounds, 
the relation of the pulse in various localities to heart im- 
pact, etc. It is only by a thorough acquaintance with nor- 
mal conditions that the abnormal can be recognized. 

There will be found frequent cases of arterial and venous 
murmurs or humming sounds that will be likely to be 
mistaken for heart murmurs. These have a location over 
the larger blood vessels and the sound is continuous rather 
than intermittent, if of venous origin, and if arterial, the 
sound is usually not heard at the heart, but at some point 
where a large trunk makes a sharp turn as in the subclavian 
artery.* The venous murmur may vary from a low hum 

* N. Y. Med. Rec, Nov. 5, 1887. " An undescribed arterial murmur,'' 
by H. H. Seelye, M.D. 



g^ Percussion and A uscultation. 

to a whistling sound. The jugular vein is the spot where 
the venous hum is most frequently heard, and in many 
cases a hum can be produced by an uneven pressure of the 
stethoscope, making a slight constriction in the calibre of 
the vessel. Turning the face of the subject to one side will 
sometimes produce a hum on the opposite side. This 
sound has been called by some writers an anaemic hum, 
but its cause can hardly be assigned directly to the quality 
or quantity of the blood. Anaemia might be a factor in 
the production of the sound by causing a softening of the 
tissues supporting the vessel, and the watery venous blood 
may be sonorous to a larger extent than arterial blood, as 
taught by Walshe, but the direct cause must be the uneven- 
ness of the calibre of vessels, through which blood must be 
flowing at a speed bearing some relation to the size of 
their lumena. 

Arterial murmurs may be due to roughness of the inner 
coat due to inflammations or vegetations, sacculations, or 
pressures. These causes would produce systolic murmurs 
that would be loudest over the site where they are produced. 
From similar causes murmurs may be produ<:ed in the 
cavity of the heart itself. Another class of murmurs is 
found in extremely nervous people, excessive tobacco 
users and over-trained athletes. It is due to irregular 
muscular action of the heart, with consequent imperfect 
closing of the valves, and is therefore systolic and heard 
more commonly over the base of the heart. These mur- 
murs are not constant, and do not frequently, if ever, 
exist with benign hypertrophy. 

Heart murmurs due to dilatation of the cavities from 
anaemia do occur, and in those cases it is difficult to decide 
whether there is aortic obstruction or a simple dynamic 
i;nurmur. In the first case, however, we would find a 
powerful heart impulse from hypertrophy, while in the 
second there would be a feeble impulse from the imperfect 
contractions. At times the respiratory sounds may con- 
fuse the heart sounds by the air being driven out of a 



Percussion and A usciUtatioji. g^ 

portion of the lung by the heart impulse, giving rise to a 
sound that may be mistaken for a heart murmur. This 
sound would be systolic and not heard at the apex. 

It is well, then, in examination, to apply the stethoscope 
to the apex of the heart first and then over the base, listen- 
ing carefully to the valvular sounds and asking the subject 
to suspend respiration in expiration for a moment if any 
abnormal sound is heard. Then listen over the carotid 
and subclavian arteries on each side. If a humming sound 
is heard that can not be understood, let the subject take 
some of the gentler strength tests, and after a slight accel- 
eration of the pulse listen again, and so proceed until he 
understands the case. The case may not be one to be 
determined in a few minutes or days. 

In listening to the sounds of the lungs we must also have 
a fixed idea of the normal before endeavoring to study 
abnormal sounds. In perfect health the normal vesicular 
murmur of the lungs varies within quite wide limits of 
force, pitch, quality and duration, due to the difference in 
thickness of the chest wall and the activity of respiration in 
different individuals, but the general character of the 
sounds remains the same. 

This sound has been likened to the faint rustling of dry 
leaves or straw, but the only description that is of help to 
a student, is the one that he makes to himself by continuous 
use of the stethoscope and naked ear applied to the chest. 

The following points may be borne in mind as helpful 
in examination : 

ist. The murmur is shorter in expiration than inspira- 
tion, and in some cases the murmur is entirely suspended 
during expiration. 

2d. The murmur is harsher over the region of the larger 
bronchial tubes, becoming milder as we pass downward to 
the base. 

3d. The heart sounds will tend to confuse the lung sounds 
in the front of the left lung, but only in a few cases is it 
difiicult to hear only the sounds you search for. 



g6 Percussion and Ausciiltation. 

4th. The sounds of bronchial breathing are heard in 
simple, uncomplicated form, over the trachea and upper 
sternal region. 

5th. the quality of bronchial respiration sound is tubular 
and harsh ; the pitch is high. 

6th. The expiration sound is longer than inspiration in 
the region of pure bronchial breathing. 

7th. Vesicular or fine respiratory murmur is heard to 
the lower margin of the lung tissue. 

8th. If the murmur ends abruptly at any point above the 
natural border of the lung, and the murmur is normal, 
suspect an effusion into the chest cavity. 

9th. Normal flatness may begin as high as the sixth rib 
on the right side, and at the seventh on the left. 

The abnormal respiratory pounds are called rales. They 
are in general of the bronchial type rather than the vesicu- 
lar. The sounds may be dry and rasping as when the tubes 
are contracted by an inflammation at the initial stage or a 
spasm of the muscular fibres of their walls or by local pres- 
sure. The sounds are called moist when the tubes are ob- 
structed by more or less fluid. These rales may be so loud 
as to obscure the vesicular murmur. 

The crepitant rale is a fine dry, crackling sound, heard 
in the last part of inspiration in pneumonia and phthisis, 
and has been compared to " the sound produced by rubbing 
a small wisp of hair between the thumb and finger near 
the ear," " pulling postage stamps apart," etc. 

The subcrepitant rale is heard in bronchitis, pneumonia, 
oedema of the lungs, phthisis, etc. It is a fine, moist, 
bubbling sound, heard in both inspiration and expiration. 

Coarse bronchial rales are heard in bronchitis, phthisis, 
etc., and are caused by mucous interrupting the flow of air. 
These rdles may be so loud as to be heard without applying 
the ear to the chest and if the mucous is very dry a whist- 
ling sound will be produced. 

Gurgling rales are sometimes heard, especially if the 
subject is very weak and can not expel thin mucous from 



Percussion and A uscultation. gy 

the larger tubes or if there is a cavity in the lung from 
tubercular degeneration. 

Aside from the respiratory sounds the vocal resonance 
is of importance in determining the condition of the lungs. 

I. — The laryngeal voice is heard over the trachea and large 
bronchial passages, while in the general area of the chest 
the sound is modified and softened, until the vocal expres- 
sion is lost except over the right bronchus, and, in thin 
persons, the left. 

2. — This tone with '' far-away " quality is known as the 
pulmonary resonance. It corresponds to the vocal fremitus 
of palpation. 

3. — Increased resonance indicates some consolidation of 
the lung without closure of the bronchial tubes, cavities, 
pleuritic adhesions or compressed lung tissues from 
effusions. 

4. — Diminished resonance is due to obstruction of the 
bronchi or a layer of fluid between the lung and chest wall. 

5. — Suppressed resonance is caused by large effusions in 
the pleural sac, with compression of the lung or new 
growths. 

6. — Broncophony or a development of the bronchial type 
of resonance in unusual locations indicates a condensation 
or hardening of lung tissue, or cavities. 

7. — Amphoric resonance indicates very large cavities, or 
pneumohydrothorax. The quality of the sound is musical 
and metalic ; the pitch is high and the resonance hollow 
and without articulation. 

8. — Whispered resonance is found in as many forms as 
vocal resonance, and its modifications are due to the same 
causes. It is a more delicate test of slight consolidation- 
and hence should be thoroughly studied. In normal cases 
it presents a soft blowing sound at the upper part of the 
chest only, where consolidation usually begins. 

9. — A cough resonance is helpful at times in securing 
cumulative evidence of a condition suspected from other 
sources of information. This is specially true of the diag- 
nosis of cavities. 



CHAPTER VIII. 

THE SIGNIFICANCE OF CERTAIN PHYSICAL SIGNS. 

In considering the sounds of the heart it is well to bear 
in mind the anatomical features of the heart, and the course 
of the blood as it passes into the heart and through it to 
the aorta. The blood from the lower parts of the body is 
conducted by the inferior vena cava to a point near the 
heart where it meets the current brought from the upper 
parts by the superior vena cava, and unites with it to form 
the innominate vein which empties into the right auricle 
after a length of 30 to 40'°". There is no valve at the 
mouth of this vein, but blood can flow backward through 
it under pressure. The right auricle is a pouch-like sac 
with only a small amount of muscular fibre in its wall. 
This auricle acts as a reservoir of a fairly steady current 
whose contents are discharged at intervals into the ven- 
tricle or muscular compartment directly below it. This 
act of discharge is easy during the period of diastole or 
relaxation of the ventricular muscle, and is accomplished 
by gravity and the contraction of the auricular walls. 
When the ventricle is distended with blood the muscular 
walls begin to contract, and the blood is forced toward the 
two openings, the pulmonary artery and the auriculo- 
ventricular passage, but this latter is fringed by the tri- 
cuspid valve which is quickly closed by the current and 
»the blood sent on, to the lungs. At the opening of the 
ventricle into the pulmonary artery there is a valve com- 
posed of three semilunar flaps of pocket shape, which pre- 
vents a return current after the contraction or systole has 
ceased. 

After passing through the pulmonary tissue the blood 
comes back to the left side of the heart and enters the left 



The Significance of Certain Physical Signs. gg 

auricle by the pulmonary veins which are ungarded by 
valves to prevent a regurgitation. The right auricle is 
very similar to the left in function and anatomical charac- 
ter. From it the blood passes down into the left ventricle 
during its period of diastole, and is prevented from flowing 
back during the powerful contraction of the ventricle by 
the mitral or bicuspid valve. This closure of the auricular 
orifice leaves only the opening of the aorta by which the 
blood must be driven out, and which then conducts it to 
the general circulation. At the aortic opening are located 
semilunar valves to retain the blood that has once passed 
into the arterial trunk, so that it can not flow back and 
refill the ventricle during its period of receptivity. 

It is clear, then, that in normal heart action we must 
have four valvular sounds, and these must all originate at 
points at no great distance from each other. In fact a 
circle of 25™™. radius drawn from a center at the sternal 
end of the fourth costal cartilage on the left will cover the 
four valves. There are points, however, where each sound 
is heard more plainly, and these are for the mitral valve at 
the apex of heart ; for the aortic valves at second inter- 
costal space just at the right of the sterum, and over the 
right common carotid artery ; for the tricuspid valve at 
middle of the sternum at the level of the nipple ; for the 
pulmonary valve at the left of the sternum in the second 
intercostal space. The mitral and tricuspid sounds must 
be at the beginning of the systole, and are called the first 
sound of the heart while the semilunar closings will be at 
the end of the systole, and are called the second sound of 
the heart. The first two sounds are synchronous, and also 
the last two. 

The first sounds are prolonged by the muscle vibration 
into a full booming sound, while the second sounds are 
short and clicking. Foster illustrates the difference by 
pronouncing the words loob-diib in the same relative time 
as the heart sounds. Between the second and first sounds 
is an interval that is essentially two-fifths of the time 



700 The Significance of Certain Physical Signs. 



required for a complete cycle of heart action. This is 
called the period of rest. 

The following table is a summary of normal heart 
sounds : 

NORMAL HEART-SOUNDS. 



Sounds. 
I. Muscular. 



2. Mitral 



valve. 



3. Aortic 



valve. 



4. Tricuspid 
valve. 



5. Pulmonafy 
valve. 



Location. 

Within boundary limits 
heart or precordial area. 



of 



Behind the 3rd left intercostal 
space and 4th costal car- 
tilage about 20™™. from 
sternum. 

Behind the left edge of the 
sternum at the level of the 
3rd intercostal space. 



Behind the sternum at the 
level of the 4th costal car- 
tilages. 

Behind the junction of the 
3rd costal cartilage with the 
sternum on the left. About 
in front of the aortic valve. 



Where Heard. 

Heard best at apex and 
just above. 

Just above apex beat 
and at 3rd intercostal 
space on left of ster- 
num. 

At 2nd intercostal space 
on right of sternum, 
and over the common 
carotid arteries. 

At lower end of the 
sternum above the en- 
siform cartilage. 

At 2nd intercostal space 
to left of the sternum. 



The boundary limits of the heart as given by Holden are 
as follows : 

For the base draw a horizontal line over the third costal 
cartilages extending 12°"°. to the right and 25™"". to the left 
of the sternum. For the apex draw a perpendicular line 
50™™. long downward from the left nipple and from its 
lower extremity draw a horizontal line 25°^™. to the right, 
which will bring the pencil over the apex to the heart in 
the fifth intercostal space. The nipple is usually located 
over the fourth intercostal space. From the apex draw a 
curve to the end of the sternum, and continue it up more 
sharply to the right edge of the sternum, and continue it 
upward to the right end of the base line by a gentle curve. 
The left side will be marked by a curve of about 200""™. 
radius extending from the left end of the base line to the 
apex. See Fig. 19. 

The part of the heart not covered by lung tissue is incon- 



The Significance of Certain Physical Signs. loi 

siderable, and is described by Dr. Latham as being outlined 
roughly by a circle of 25™™. radius drawn from a center 
half way between the nipple and lower end of the sternum. 
Fig. 20. 

Abnormal heart sounds are usually called murmurs, and 
result from four causes : 

1. The failure of valves to perfectly hold the blood from 
leaking through. 

2. The narrowness of the opening through which the 
blood is forced into a tube of larger caliber. 

3. Friction of the external surface of the heart against 
an inflamed pericardium. 

4. Friction on endocardium from vegetations. 

The first cause may be due to active inflammation of the 
valves from endocarditis, etc., that produces vegetations or 
uneven thickening of the valves and therefore imperfect 
closure, or the walls of the heart may become so distended 
as to prevent perfect coaptation of the valves. Other 
causes also may produce imperfect closure. 

The second cause usually depends on inflammation that 
has caused a deposit of fibrous tissue around the orifice 
affected. 

The third cause is more often the result of an injury or 
strain, and is found in some cases after violent exercise. 

The fourth is found after fevers, rheumatism, etc. 

The character of these abnormal endocardial sounds is 
hissing or blowing, and for this reason they are called by 
some writers "bellows murmurs," while the friction sound 
is more squeaking or grazing in its quality, and can 
frequently be diagnosed by the fremitus discovered by 
palpation. 

The pitch varies in all the sounds from a low, gentle 
murmur to a high whistling note — the pitch giving us some 
idea as to the size of the opening ; for if the sound be 
caused by a stream forced through a small aperture the 
pitch will be higher — the surfaces set in vibration being 
much shorter than in the large opening. 

The most common heart lesion is a failure of the mitral 



102 The Significance of Certain Physical Signs. 



valve to perfectly close the left auriculo-ventricular pas- 
sage. This is called mitral insufficiency. It is plain, that 
any fault in the closing of this valve would permit the 
blood to flow back into the left auricle during systole, and 
that this would cause increased pressure in the auricle and 
pulmonary veins, thus interfering with respiration and 
distending the auricle. As the heart contraction forces 
blood into the aortic arch, there is an effort toward straight- 
ening the aortia from the pressure, and this brings the apex 
of the heart against the chest wall at about the fifth inter- 
costal space. This brings a continuous vibratory medium 
of solid tissue from the point of vibration to the external 
surface where we may receive it by the ear or stethoscope. 
We also find that the sound is carried to the left axillary 
region along the fifth or sixth rib. The sound is heard 
over the valvular region at the base of the heart but with- 
out characteristic qualities. The time of the murmur is 
during the systole, and hence it begins with the valvular 
click of the first sound and ends with the second valve 
closing at the aorta which gives the second sound. 

If the heart sounds are so deranged that it is difficult to 
decide which is the first sound, it may be determined by 
remembering that it is synchronous with the impact of the 
apex against the chest wall, and also with the pulse wave 
in the carotid arteries. 

The following sphygmogram shows the typical disturb- 
ance of the arterial pressure in mitral regurgitation Fig. 24 : 

The curve is not abrupt in the systole, 
and the pressure is not sustained to the 
dicrotic wave. If the systole is very 
energetic the pulse would be large but 
soft. The rhythm is irregular. Fig. 25 
shows mitral regurgitation with slight 
aortic insufficiency. In order to under- 
stand the meaning of 
these curves, let us 
study briefly the nor- 
mal pulse tracing. Fig. 24. Fig. 25. 





The Significance of Certain Physical Signs. loj 

"All scientific investigators agree that the 
line A represents the cardiac contraction, 
the impulse being conveyed to the needle 
through the arteries in the same manner 
Fig. 26. that the impulse is given to the last marble 

in a row of marbles by striking the first marble in the row 
a quick blow, the difference being that the row of marbles 
does not advance, while the blood current does. This 
ascent we will call the systolic wave. 

The arteries thus suddenly filled begin immediately by 
virtue of their elasticity to contract and the needle descends 
to the point B. Next we have a wave, the cause of which 
is not definitely settled. It is generally believed that the 
wave B-C, called the tidal wave, is due to a rebound of the 
blood from the terminal vessels or capillaries, for the fol- 
lowing reasons : 

The tidal wave is more perceptible nearer the capillaries. 
The base of tidal wave approaches the systolic line and 
systolic apex the farther the tracing is taken from the 
heart. 

Sweating renders the tidal wave less perceptible and the 
base nearer the dicrotic notch. 

From C the artery again contracts till the needle reaches 
point D. The rise at D is generally conceded to be due to 
the rebound of blood from the closed aortic valves and is 
usually termed the dicrotic wave. The remainder of the 
cycle represents the diastole or rest of the heart."* 
Fig. 27 shows a normal pulse 
of high tension and Fig. 28 a 
Fig. 27. normal pulse of low tension. Fig. 28. 

The lesion that stands second in frequency is obstruc- 
tion at the aortic orifice — any narrowing of this opening 
that makes its caliber less than that of the aorta will pro- 
duce a murmur and tend to increase the work of the ven- 
tricle with resulting hypertrophy. It obviously does not 

* See an article on the Use of the Sphygmograph, by Dr. J, G. Smith, in 
the Annual Report of the Amer. Assoc, for the Adv. of Phy. Ed., 1888. 



10^ The Significance of Certahi Physical Signs. 

menace life and health to the same extent as mitral insuffi- 
ciency. The sound being produced by the current forced 
out by the contraction of the ventricle it must be synchro- 
nous with the systole and end with the second sound of the 
heart. Its location being at the base of the heart, we 
would expect to find the sound clearest at the beginning 
of the aorta. It is in fact heard most distinctly over the 
sternum at level of the second rib or just to the right of 
the sternum, and is also heard over all the large arterial 
trunks of the upper thorax and neck. It is called aortic 
stenosis. 

Fig. 29 illustrates the typical pulse trac- 
ing in this lesion. The systolic curve is 
Fig. 29. not abrupt nor high, but the pressure is 

well sustained past the dicrotic notch. The pulse is small 
and usually regular. 

The third lesion in frequency is a regurgitation of blood 
through the semilunar valves from the aorta into the left 
ventricle. Evidently this can only occur during the dias- 
tole of the heart. It should be heard in the same locations 
as the murmur of aortic stenosis, and also down along the 
sternum. The lesion is termed aortic insufficiency. 

The interference with the pulse is shown by 
Fig. 30. Its characteristics are marked. The 
systolic curve is high and abrupt. The fall is 

Fig- 3°- abrupt. The dicrotic wave is small. The pulse 
is quick and strong ; the " bullet " pulse. 

The fourth lesion producing a characteristic sound is 
mitral obstruction due to stenosis of the left auriculo-ven- 
tricular passage. This would interfere with the passage 
of blood from the auricle to the ventricle in the period of 
diastole. The murmur being started during the stage of 
auricular contraction and ending with the beginning of 
the first sound ; it is called presystolic. It is heard over 
the mitral valve and at the apex of the heart, but is not 
transmitted over a large area. This lesion leads to much 
pulmonary disturbance on account of the increased blood 
pressure in the lungs. 




The Significance of Certain Physical Signs. lo^ 

The fifth lesion is obstruction of the pulmonary orifice 
from stenosis. This would place extra work on the right 
ventricle, which hypertrophies by natural accommodation. 
The murmur must be systolic and heard over the second 
cartilage to left of the sternum. It is prolonged upward 
and to left of the sternum for only a short distance as the 
artery soon divides into small branches to ramify through 
the lungs. 

The sixth lesion is a regurgitation through the tricuspid 
valves due to insufficiency of the closure. It is systolic 
and causes great increase of venous pressure by the current 
forced back into the auricle and through it into the venous 
trunks causing a venous pulse. It is heard at junction of 
ensiform cartilage with the sternum and to the apex. 

The seventh lesion is an obstruction of the right auricuio- 
ventricular opening by narrowing, and hence the murmur 
must be presystolic. 

It is heard over the middle of the sternum at level of 
fourth cartilage, and is not transmitted except to a slight 
extent downward to the end of sternum. It is called tri- 
cuspid stenosis. 

The eighth lesion is a regurgitation through the valves 
(semilunar) at the opening of the pulmonary artery, and is 
termed pulmonary insufficiency. It tends to enlargement 
of the right ventricle, and interferes with the pulmonary 
circulation and aeration of blood. In time it must be dias- 
tolic, and is heard at the region of the second left costal 
cartilage. The sound is carried along the sternum faintly. 

A murmur is transmitted, in general, by the blood and 
hence in the direction of the current. 

If these lesions be tabulated in the order of their fre- 
quency, it will be observed at once that the left side of the 
heart is most frequently affected — all possible abnormal- 
ities having representation before the most frequent mur- 
mur of the right side. The reason for this is clear when 
we consider the vastly greater extent of tissues to be 
supplied by the left side of the heart compared with the 
pulmonary circulation supplied by the right. 



jo6 The Significance of Certain Physical Signs. 



TABLE OF ABNORMAL HEART SOUNDS. 



Condition. 

1. Mitral regurg. 

2. Aortic obstruct. 



regurg. 



Mitral obstruct. 



S- Pulmon. obstruct. 



6. Tricusp. regurg. 



obstruct. 



8. Pulmon. regurg. 



Heart Sound. 
ist sound. 



After 2d sound. 



ist sound. 



After 2d sound. 



With 2d sound. 



Heart Action. 
Systolic. 



Diastolic. 



Systolic. 



Diastolic. 



Where Heard. 
Mitral area and 
apex. 

2d rt. cost, car- 
til, at sternum. 



2d rt. cost, car- 
til, at sternum. 

Mitral area and 
apex. 

2d left cost, car- 
tilage. 

Just above ensi- 
form cart. 

Sternum at head 
of 4th rib. 

2d left costal 
cartilage. 



Transmitted. 
Along 6th rib to 
axilla. 

To top of ster- 
num and arterial 
trunks. 

Down along ster- 
num. 

Not transmitted. 



Up a short dist., 
ends abruptly. 

Down a short dis- 
tance. 

Not transmitted. 



Up a short dis- 
tance. 



Lesion. 
Mitral insuf 



Aortic 

stenosii 



Aortic 
insufficiencj 

Mitral 

stenosis 

Pulmonary 
stenosii 

Tricuspid 
insufficiency 

Tricusp. 
stenosis 

Pulmonary 
insufficiency 



The exocardial murmur is due to the movement of the 
heart rubbing two inflamed and roughened surfaces to- 
gether. The pitch is usually high and quality squeaking. 
It has no connection with the valve sounds in time or 
location — is not transmitted in any particular direction, 
and if loud, may be felt as a fremitus at the apex beat. It 
has no influence on the pulse curve. 

The Pulse of Mitral regurgitation: 

(a) Compensated, is soft and often large. 

(b) Uncompensated, is soft and short (celer.) 

" " " " stenosis is small and soft (sometimes frequent and 

often irregular). 
" " " Aortic regurgitation is quick, large, " shotty pulse" (and 

regular). 
" " " " stenosis is small and long (tardus). 
" " " Tricuspid regurgitation is venous. 

There is a normal venous pulse. In time it precedes the 
arterial pulse, and may be said to alternate with it. It is 
caused by the auricular systole and the consequent stop- 
ping of the free current toward the heart. 

The abnormal venous pulse is discovered most easily at 
the lower part of the jugular vein, and is synchronous with 
the arterial pulse, being due to the same cause, namely, the 
systole of the ventricles. This indirect current can be 
forced into the veins only when there is insufficiency of 
the tricuspid valve. 



CHAPTER IX. 



PRESCRIPTION OF EXERCISE. 



The main object of a physical examination is to learn as 
many facts concerning the physical needs and tendencies 
of the subject as possible in order to be able to advise him 
properly regarding his exercise and personal hygiene. 
Without being able to give exactly the measures of a per- 
fect man or woman we must have a standard of form and 
development that is derived from a knowledge of anatomy 
and experience in observing the individuals that present 
the highest evidence of perfect health and power. We learn 
also in a negative way by a study of pathological cases. 
The persons of impaired health can usually be so classified 
in groups with common symptoms that certain physical 
signs will be found common to nearly all in the group. 
Then by a study of the history of these cases we can judge 
with some correctness whether the physical sign stands in 
the relation of cause or effect to the abnormal symptoms. 
For instance, if we group together all cases of organic lung 
diseases such as tuberculosis, chronic bronchitis, recurrent 
attacks of pneumonia, pulmonary congestion, emphysema, 
etc., and find that a very large per cent, of the cases have 
in common poorly developed respiratory muscles,flat chests, 
sagging shoulders, etc., with no other common feature, we 
may properly conclude that a chest of this type is not an 
ideal in the sense of being a model toward which we should 
endeavor to conform the flexible chests of our people. 

But our inference might be very far from truth and un- 
trustworthy if we did not also approach the subject from 
a different line of study and reach the opinion in a positive 
way. We do this by grouping the individuals that have 



loS . Prescription of Exercise. 

proved their ability for enduring prolonged mental and 
physical strain, the superior individuals of society like 
Bismark, Gladstone, Greeley, Webster, etc. If we find in 
this group the physical conformity of chest exactly oppo- 
site to our other group, we have added to our knowledge 
of what should be avoided, a type that may wisel}^ be fol- 
lowed. 

It is often a question how far the aesthetic sense may 
guide us in deciding as to a physical standard. The eye 
will ordinarily be pleased with the form that has scientific 
perfection. A well rounded and developed body is more 
pleasing than a lax, untrained one, but there may be senti- 
ments and unjust standards of criticism, the result of faulty 
training in youth, that bias even our judgments of beauty. 

This is seen everywhere in the world of fashion. A head 
of hair that is considered beautiful and becoming one sea- 
son must be bleached or dyed to some other color in order 
to be " perfectly lovely " the next. This depraved taste 
that approves of a pale face and crooked spine in a student, 
and a narrow waist with constricted chest and pelvic dis- 
placements in a woman, must be educated up to the scien- 
tific and artistic standard. We must show in the gymna- 
siums that increased health means not only increased 
ability, but increased beauty, and that health is only a 
correct balance of functional activities. It cannot exist in 
perfection if one part is under-developed or over-developed. 
* This brings us to the first point in prescription. If we 
discover an abnormality of shape due to extraneous causes 
we should first prescribe the removal of these causes when 
possible. To forget this would be to give medicine to 
counteract a poison while permitting the patient to ingest 
the deadly substance. In work with both sexes the matter 
of dress should be inquired into where we find any suspi- 
cious abnormality of shape. This is especially true of con- 
strictions of the trunk. Boys will often wear a belt in im- 
itation of some noted "slugger" or local "tough," or for 
other reasons known only to themselves. The injurious 



Prescription of Exercise. log 

efifects are the same as may be seen in the case of corset- 
aflEiicted women ; weak lumbar muscles, narrow loins, 
pendent abdomen, varicose veins, costal respiration, diges- 
tive ailments, etc. 

The muscular weakness can not be cured while circula- 
tion is impeded by pressure on the fibres ; the narrow waist 
can not be brought out into correct outline, to give room 
for a proper location of the digestive organs, that would 
relieve the supra pubic distention, while every force is 
crowding them down into the pelvis. 

The respiratory act should be unimpeded or imperfect 
oxidation will result and this means virtually an enforced 
vitiated atmosphere. A reduction of waist-girth by 50™™. 
is shown by Dr. Sargent to reduce the lung capacity twenty 
per cent. A number of persons with an average lung ca- 
pacity of 2.70 litres, and waist girth of 710™™. were found to 
have a lung capacity of only 2.15 liters when the waist 
girth was reduced to 660™'". 

A reduction of the oxygen in the air by diluting it with 
nitrogen or carbon dioxide to the extent of one-fifth (20 
per cent.) would soon be disastrous to active life. Again, 
constriction of the waist calls for an entirely artificial 
method of respiration, as has been conclusively shown by 
Dr. Kellogg, through whose courtesy the following illus- 
trations of normal and abnormal respiration are given on 
pages no, III, 112. 

After looking at these illustrations, that explain them- 
selves, two questions might be suggested by any person 
not fully acquainted with Anatomy and Physiology: ist. 
Does not the amplification of the costal curves during com- 
pression show that the respiratory act is fairly complete — 
one set of muscles acting when the other is impeded ? This 
view has been presented in articles by Dr. Mays, to which 
reference has already been made, who attempts to show 
that this method of breathing may tend to prevent tuber- 
culosis by causing a better action of the apices of the lungs 
where that disease usually locates. The only support 
brought to this theory was the fact that more men than 



PLATE I. 




Costal. 



Abdoxuinal. 



Fig. 1. Man. 




Costal. Abdominal. 

Fig. 2. Civilized "Woman (Unmarried, age 33 years). 




Costal. 



Abdominal. 



Pig. 3. Chinese Woman. 




Costal. Abdominal. 

Fig. 4. Indian Man (Chickasaw). 




Costal. AbdominaL 

Fig. 0. Indian Woman (Chickasaw). 




Costal. Abdominal. 

Fig. 6. Chippeway Indian Woman. 



PLATE II. 




Fis. 



Costal. Abdominal. 

A Scotcli Woman, who has never worn a corset (age 45, nnmamed). 




Costal. Abdoniinal. 

Fig. 8. A Reformed Corset-wearer (ordinary respiration) 




Costal. AoaonuBaL 

Fig. 9. Reformed Coreet-wearer (forced respiration). 




Costal. Abdominal. 

Fig. 10. Young Woman in Corset. 



Costal. 

Fig. 11. 



Abdominal. 

Man in Corset. 





Costal. Abdominal. 

Fig. 18. Male Dog. 



postal. Abdominajl: 

Fig. 18. Female Dog. 



PLATE III. 





Costal. Abdominal. 

Fig. 14. Woman at Seventli Month of Pregnancy. 



Costal. Abdominal. 

Pig. 15. Woman, a Week Before Confinement. 




Costal. Abdominal. 

Fig. 16. Man with Enlarged Spleen. 




Ordinary. Forcedi 

Fig. ir. Respiratory Tracing (Vaginal). 



Ordinary. Forced. 

Fig. 18. Vaginal Tracing, with Corset. 




Without Corset. Xishtening With Corset. 

Corset. 

Fig. 19. With and Without Corset. 



Prescription of Exercise. iij 

women die of pulmonary tuberculosis ; but when we re- 
member that this disease is largely due to climatic influences 
of which wide and sudden variations are the chief feature, 
and that men are more exposed to these variations than 
women, the argument seems worthless. 

But even if we concede a possible safeguard against tub- 
erculosis in tight lacing we must still look upon it as a 
case where the remedy is worse than the disease, or a dis- 
guised blessing of the kind described by " Josh Billings," 
who remarked that " tight boots are a blessing, inasmuch 
as they cause a man to forget all his other miseries." 

2nd, If costal respiration is prejudicial to health why do 
we not have a larger death-rate from acute lung diseases 
and other diseases directly traceable to interference with 
respiration ? 

The reply is ready that the impaired activity of one organ 
rarely gives evidence in physical signs of its abnormality. 
Even as sensitive an organ as the brain may disclose its 
disordered function, not by pain in the head, but by an ab- 
normal secretion in some remote organ ; or a disease of the 
kidney be discovered by its causing an organic change in 
the heart. The lungs are ordinarily capable of enduring 
great hardship. Their flexibility enables them to conform 
to any shape of the thorax or to be compressed for a long 
time by a pleuritic effusion, or other cause, without per- 
manent injury, as is frequently seen in cases of extreme 
kyphosis. According to the statistics of the New York 
Mutual Life Insurance Co., consumptives average one and 
a half inches less in chest girth than non-consumptives. 
But meanwhile how fare the organs that are dependant 
on good blood ? The brain can not act well from the in- 
stant unoxidized blood which flows in to supply it. Low- 
ered vitality is the result with a yielding to acute diseases 
of every kind. Many a death is recorded as due to typhoid 
fever, peritonitis, malaria, etc., that is really due to a defi- 
cient respiration when the system requires the most active 
oxidation. The respiratory power is recognized as of the 
highest importance in all acute diseases. 



ii/f. Prescription of Exercise. 

We must see to it, then, that no article of clothing inter- 
fere with the free action of every organ. 

The same care must be exercised in judging whether or 
not a bad form is due to faulty habits of posture. If the 
respiration is checked by a position that brings a bend in 
the trunk with a depression across the upper part of the 
abdomen, as is the case when one slides forward in his seat 
until the sacrum instead of the ischia bears the weight of 
the body, the same ill results will be found that are noticed 
in tight lacing. 

The horizontal depression due to the above cause will 
sometimes be found as high as the fifth rib and we can 
readily understand the interference with circulation that 
must exist in such cases. In all there will be more or less 
disturbance of the hepatic function, impaired digestion, 
constipation and atrophy of the lumbar muscles. 

The muscular condition of the loins and abdominal wall 
can tell us much about the digestion and nutritive powers. 
If these muscles are weak we must point out the fact with 
emphasis and order such exercises as shall tend to give 
strength and activity to them. The small size of a man's 
biceps or gastrocnemius often troubles him when his real 
anxiety should be regarding his erector spinae or rectus 
abdominalis. 

It is the essentials that we must lay stress upon in our 
prescriptions, for the other parts will get incidental exer- 
cise in almost every case. A person's arm will always be 
large enough for the ordinary demands of life upon it — his 
heart may not be ; his leg will always be strong enough to 
fill every requirement — his stomach may fail utterly. A 
man may have life and fair health with complete loss of 
some muscles, while others act at the seat of life itself. 

A class of cases will come under the care of the instruct- 
ors in the gymnasiums of Schools and Colleges that will 
be rarely met by the Directors of other gymnasiums ; a 
set of boys and girls who have been overworked mentally 
and underworked physically, until the nervous side of 



Prescription of Exercise. 115 

their lives is far in the ascendant. The whole idea of 
physical exercise has become repulsive to them because 
their muscular tissue is so weak that any fair activity 
begets great weariness, and sometimes even lameness. 
Brain work is easy for them because it has become the 
habit of their lives ; they can generally accomplish great 
feats in the way of bearing severe strains of short duration, 
both mental and physical. They can sit up all night pre- 
paring for an examination, and the next day are bright 
and ready for good work, or, at the time of physical exam- 
ination they show a surprisingly high record in strength 
tests, but come in the next day to tell of a strained back or 
lame shoulder as the result of their lifting. They make 
good athletes, but are continually getting over-trained. 
They invariably do too much. 

Is gymnastic work advisable for such persons ? An 
affirmative answer can only be given when there is to be 
personal supervision of the work. The boy of high nerv- 
ous organization needs exercise quite as much as one who 
has no tendency to abnormal nerve activity, but it must be 
of a different character, for the results sought are dissimi- 
lar. The nervous person does not live enough in his 
muscles. His habit is to make excursions out into his 
extremities, and after stirring them up and making every 
tissue tingle he retires, to leave each muscle exhausted 
and every energy depleted. The exercise prescribed for 
these cases, and enforced by personal supervision, must be 
light, and continued over a long period of each day. To 
satisfy the mental requirement of the case the work must 
be made attractive, either as a game or a personal contest 
between individuals. In a few cases such an interest in 
the physical welfare can be excited in the subject as to 
take the place of this mental interest that is stimulated by 
games, and a person will do routine work that is laid out 
simply from the enjoyment that he gets from visible im- 
provement. 

Athletic work, on the other hand, is too stimulating to 



Ii6 Prescription of Exercise. 

the nerve centers to be advisable for such cases. The ex- 
citement of contests will leave a person exhausted, for it 
I will continually lead him to over-exertion.. This objection 

does not apply to those contests where skill rather than 
great strength is the source of excellence. 

Many of these persons, if uncared for in the gymnasium, 
would shortly fall into the hands of a physician as typical 
cases of neurasthenia, and rest must often be prescribed 
instead of exercise. The Swedish system of passive move- 
ments, or massage, gives us an opportunity to develop 
muscular tissue even while the patient is resting, for the 
passive motion of the muscles tends to stimulate the circu- 
lation in the same way as active exercise, and consequently 
the nutrition and growth of the part is actively promoted. 

Comparatively few people understand what is meant by 
complete rest. The complete relaxation of every tissue 
is a requisite of rest, and a habit of relaxation by an 
act of will can soon be secured. There are many noted 
cases of this ability to even sleep by an act of sheer will 
power. One of the most useful features of the Delsarte 
system lies in the attention that is paid to this idea of 
physiological rest. The effect of sunlight on these Neuras- 
thenic cases is almost always favorable, and consequently 
outdoor work should be prescribed in preference to indoor 
work. 

In marked contrast to the cases mentioned the athlete 
may be placed. Advice in regard to exercise will be 
sought, and such exercise must be prescribed as will tend 
to secure a development of the muscles that are least used 
in the particular form of exercise in which the athlete en- 
gages. Again, after a severe course of training for any 
athletic event, many cases will find discomfort from local 
congestions on account of an over-activity of the heart 
during the period when there is no great physiological 
"wear and tear" to require a very active circulation. To 
meet these cases a course of training must be laid out that 
shall be graduated from heavy work down to light, so that 



Prescription of Exercise. iiy 

the person may slowly accustom himself to the new con- 
ditions under which he must live. The heart of an athlete, 
who has been properly trained, is usually in good condi- 
tion, and a very small percentage develop any heart lesion 
during their training, but a large strong heart may be an 
actual disadvantage to a man leading a sedentary life, as a 
puny, feeble heart surely is. 

The examiner will find many cases of debility and ner- 
vous irritability. Among men a large per cent, of these 
cases will be inordinate users of tobacco. The very first 
glance will betray to the experienced eye the " something 
wrong," but we must always remember that some of the 
most persistent users of tobacco are strong and hearty 
while a few of those who do not use it are weak and ner- 
vous. How then shall we say to a person who asks our 
advice whether he is suffering from nicotine poisoning or 
not? 

In the first place the heart action under continued in- 
fluence of nicotine is peculiar and attention is called to 

the sphygmo- 
gram, Fig.31, 
of a typical 
Fig. 31. pulseofa 

" tobacco heart," from the Reference Handbook of the 
Medical Sciences. It will be noticed that the first two 
beats are essentially normal with the tidal wave as marked 
as the dicrotic. The interval between the second and third 
waves is longer than the first which may be considered the 
normal for this case. The third interval is short and the 
dicrotic notch deep while the systolic wave is not high. 
The fourth interval is normal ; the fifth longer and fol- 
lowed by a very faint impulse after which the heart again 
rallies, and so on. 

The character of this pulse as felt at the wrist is irreg- 
ular and tremulous. A beat or two of high tension fol- 
lowed by one of low, or there may be no rythm discover- 
able. 



ii8 



Prescription of Exercise. 



These cases should be studied carefully and can readily 
be distinguished from the frequent pulse of nervous ex- 
citement or Ihe palpitation and irregularity of chronic 
indigestion. In perhaps three-fourths of the cases there 
will be some nervous excitement attendant on the new 
experiences of a thorough examination but this influence 
on the pulse may be either quickening or depressing, and 
these changes come not for single beats but during cycles 
covering many pulsations. 

An intermittent pulse may not be an indication of serious 
interference with health or longevity and may not be due 
to any appreciable cause. The omission is then usually 
found at stated intervals not very short, but from ten to a 
hundred beats apart. 

Of course the examiner's duty is clear in each discovered 
case of smokers' irritable heart, and it is only suggested 
that other narcotic stimulants, like tea and coffee, will pro- 
duce effects that are nearly similar. In these cases the 
exercise recommended must be light, and such as tends to 
relieve the circulation. 

The following form of blank prepared by Mr. C. M. Williams of the 
St. Louis Y. M. C. A. Gym. is the best of the many that have come 
under the author's notice where personal explanations can accompany 
the directions : 



Apparatus. 



Move- 
ments. Times. 



Chest Weights . 
Giant Pull. " ., 
Low Chest " - 
Split H'dle Giant 
Intercost. Mach. - 
Abd. Giant Pull.. 
Quarter Circle . 
Rowing Machine 
ScullingMachine 
Paddl'g Mach. . 
Chest Expander . 
Leg Developer . 
Leg Developer _ 
Neck Machine . 
Forearm Devel. . 
Abdominal Stool 
B'k&LoinPuU. . 
Finger Machine . 
Paral. Bar Mach.. 
Parallel Bars.. . 
Horizontal Bar _, 
Vaulting Bar.. _ 



Weight. 



Apparatus. 

23. Vertical Bar .. 

24. Floor Bars 

15. Incl. Chest Bars 

26. Ver. Chest Bars 

27. Susp. Par. Bars 

25. Vaulting Horse 

28. Vaulting Buck 

29. Inclined Ladder 

30. Horizont'I Lad. 

31. Climbing Ropes 

32. Peg Pole 

33. Climbing Pole 

34. Striking Bag.. 

35. Kicking Appar. 

36. Jumping Stand. 

37. Flying Rings. 

38. Traveling Rings 
40. Spring Table.. 

Bar Bells 

Dumb Bells... 
Indian Clubs . 



Move- 
ments. Times. 



Weight. 



Prescription of Exercise. iig 

The following directions prepared by Dr. J. G. Smith are more intel- 
ligible where the person has no direct supervision in his work : 

1. For Grip and Forearm — Opening and shutting fingers with or 
without resistance, (a) wrist roller : (3) clubs ; (c) bells ; (</) horizontal 
bar and {e) rings. 

2. Front Arm — Any exercise bending the elbow joint against resist- 
ance especially while rotating the thumb outwards ; such as {a) curling 
dumb bells ; {U) the pull up ; (c) the rings ; {d) the horizontal bar ; (e) 
the high parallels ; (/) the pulley weights ; {g) climbing ropes and 
ladders. 

3. Back Arm — Any exercise straightening elbow against resistance ; 
{a) pushing up dumb bells ; (b) dip on parallels ; (c) traveling parallels ; 
(d) pulley weights ; (e) striking bag ; (/) chest bars, either straight or 
inclined ; {g) work on horse or buck. 

4. Shoulders — Any exercise carrying the arm from the body against 
resistance, either front, back or out, with (a) bells ; (b') clubs ; {c) pulley 
weights ; (d") wands, etc. 

5. Neck — Bending head back, front or sideways against resistance of 
the hand or neck machine. 

6. Chest Muscles — Any exercise tending to bring the arms across 
the body, whether front or back, or raising the body when arms are 
fixed, as (a) pulley weights ; {b) parallels ; {c) horizontal bar ; {d) travel- 
ing parallels ; {e) high parallels ; (/) ladders ; {g) chest expanders ; {h) 
giant pulleys ; (j) rings ; (/) quarter circle. 

7. Abdominal Muscles — Any exercise tending to bend the body 
forward against resistance ; such as («) quarter circle ; (U) abdominal 
mat and stool ; {c) raising from a reclining to a sitting posture ; {d) pul- 
ley weights ; (e) giant pulleys ; (/) the " L" on ladders, rings, horizontal 
and parallels. 

8. Back — Any exercise straightening or bending the body back 
against resistance, such as (a) rowing ; {b) low pulleys ; (c) dumb bells ; 
(^) free-hand and setting up drills, {e) wands. 

9. Front Thigh — Any exercise bending the hip or straightening the 
knee against resistance ; {a) leg work of free-hand and dumb bell drills ; 
{b) running ; (c) hurdling ; (d) jumping ; (e) leaping ; (/") rowing ; (g) 
leg machine. 

10. Back Thigh — Any exercise bending knee or straightening hip 
against resistance, {a) Second motion of West Point Setting Up Drill ; 
(b) leg work of pulley weight drills ; {c) free-hand and dumb bell drills ; 
{d) striking bag. 

11. Front of Leg. — Any exercise raising toes, or tending to carry 
body forward with bent knee against resistance ; («) pulley weights with 
back towards them ; (b) leg work of dumb-bell and free-hand drills ; 
(<:) ankle machine. 

12. Back of Leg — Any exercise raising the body on the toes. All 
exercises for front of thigh ; ankle machine. 



120 



Prescription of Exercise. 



For all around development with light apparatus no better work has ever 
been devised than the dumbbell drill of R. J. Roberts. 

Roberts' Gymnasium Dumbbell Drill No. i, . 



Div. I— Free Work. 



Open and shut fingers. 

Wrist shakes. 

Wrist extensions. 

Small circles. 

Arm quivers. 

Yawn stretch. 

Windmill down in front of face. 



8 Same down through sides horizontals. 

9 Milkman's slap. 

10 Back neck exercise. 

11 Sternum expression. 

12 Out-door breathing work. 

13 In-door breathing extensions. 

14 Massage. 



Raise high on tip-toes. 
Raise sharp on heels. 
Combine one and two. 
Ankle cradle rock. 



Squat half way down. 
Squat all the way down. 
Combine one and two. 
Front hammer. 
Side hammer, No. 2. 



1 Side push. 

2 Sternum elevator. 

3 Cradle rock. 

4 The chop — vocal. 

5 Shoulder raiser. 

6 The cut — vocal. 

7 The cut — stretch. 

8 Liver squeezer. 

9 The flip. 

10 Yawn stretch. 



Div. 2 — Leg Work. 

5 Spread eagle. 

6 Raise on toes and roll the shoulders 

back and down. 



Div. 3 — Thigh Work. 

6 4 count side pull the string. 

7 Spring board jump. 

8 Jump rope. . 

9 Stationary run with %, % turns and 

arm expressions. 

Div. 4 — Body Work. 

11 Forward push — vocal. 

12 "A" walls. (Jump feet together on 

last count.) 

13 Push to sides horizontals. 

14 Muscular chest. 

15 Vertical push (pull the string.) 

16 Dry land swim (forward hammer.) 

17 Same side hammer, No. 2. 

18 The 32 count, Nos. 1,4,6,9, 11, 13, 15. 



1 Biceps — up hard. 

2 Triceps — down hard. 

3 Combine two and one. 

4 Triceps, vocal — Hello. 

5 " " —Ah. 



Div. 5— Arm Work. 

6 Triceps, vocal — Sh. 

7 Tricep swing (st. exp.) 

8 Wrist twists. 

9 Wrist curls. 
10 Yawn stretch. 

Div. 6 — Extension Work. 



1 Forward sweeps. 

2 Side sweeps. 

3 Strike, hard, behind heels and under 

chin and over head. 

4 Clavicular exercise. 

5 Trapezius squeeezer. 

6 Strike behind thighs and under chin. 



7 Strike over head and under chin. 

8 Combine six and seven. 

9 2 count side pull the string. 

10 Repeat No. 7 and pull the string. 

11 The scoop, (do slowly.) 

12 The toe yawn stretch. 



Prescription of Exercise. 121 

For cards or prescription blanks to be furnished to the 
individual examined many devices have been originated, 
the principal ones, containing a list of the measurements 
of the person, on which is marked the parts that especially 
need development, while on another, part of the card is a 
reference either to apparatus or to the form of exercises 
that will specially tend to develop those parts. The 
standard that is commonly used on these cards is an 
average made up from the measurements of a large num- 
ber of individuals. The question of what is a typical or 
ideal man is still an open one, however, but perhaps no 
better idea of such a man can be gained at present than 
the measurements illustrated in the chart of Dr. E. Hitch- 
cock, Jr., as shown in Appendix 4. 

We should have a standard of marking physical excel- 
lence or deficiency in a numerical way that shall in some 
way correspond with the mark that is given on examination 
for intellectual accomplishments. Francis Galton, in a pa- 
per prepared for the American Association, suggests that 
attention be given to this point, and says : " I would ask to 
be permitted to suggest a subject, or rather a very interest- 
ing class of subjects, that fall under this head ; it is to in- 
vestigate the best method of assigning marks for physical 
efficacy based on anthropometric tests. The colleges of 
America would greatly help in a good cause by working 
on the general lines suggested in this paper. I see no 
reason why a man's physical efficacy should not be valued 
in terms simply of the number of marks awarded on a well 
understood system, nor do I see any reason why an 
employer, making his selection among many candidates, 
should not hereafter, at some not distant time, be in- 
fluenced in favor of that candidate who possessed a certifi- 
cate of having been awarded high marks. Man is a 
machine of flesh and bone, and a good machine of any 
kind is worth more than a bad machine." 



CHAPTER X. 

GRAPHIC ANTHROPOMETRY. 

Within the last six years various devices for applying 
the principles of graphic mathematics to the measures and 
tests of men have been invented. These have been the 
outgrowth of the graphic method of Quetelet for showing 
the mean of any part, as chest girth or height, and the tables 
of averages and means published from time to time during 
the last twenty-five years by Dr. Hitchcock of Amherst 
and the tables of percentages published by Francis Galton 
and other students of anthropology. 

The oldest record of anthropometrical data in any col- 
lege in the country is to be found at Amherst, where from 
1 86 1-2 to this date the students have had the advantage of 
a physical examination, and advice regarding exercise and 
a record of their general size has been secured. In 1881 
Dr. D. A. Sargent proposed a more extensive list of items 
for measurement after the plan of Dr. W. T. Brigham of 
Boston and the European studies in anthropometry. In 
the following year this plan was adopted at Amherst, and 
in 1883 at Yale. 

The order of items as originally arranged by Dr. Sargent 
has been rearranged in a better order for graphic represen- 
tation if not a more logical order by the author in his an- 
thropometric table and the recent record books of Yale. 
This list of items with only slight modifications is now in 
general use in all educational institutions where there is an 
aim at complete methods and the highest results. 

The items given on Dr. Hitchcock's table page 126 are 
extended in the record book of Yale by the addition of age, 
breadth of chest, development, condition, exercise, vision, 
hearing, color of hair and eyes, pulse rate, and use of to- 
bacco. The horizontal length is omitted. It may be said 
in further explanation of these tables of Dr. Hitchcock that 



Graphic Anthropometry. i2j 

the record of each student is transcribed for him on a table 
that is compiled from the measurements of men of the 
same height as the subject — the table here shown being the 
one that would be given to the man of average height or 
1725"". 

In 1878 Dr. D. A. Sargent of Harvard began a system- 
atic record of measurements of students examined by him- 
self, and with the enthusiasm which he excited in the edu- 
cational world by his abundant preparation for the work, 
his natural ability and his unequaled field for observation, 
he soon established a school for training teachers in the 
theory and practice of gymnastics, and sent out many able 
instructors imbued with his ideas and ready to assist him 
in the development of a plan for the determination of some 
physical standard for American college students that should 
be derived from a tabulation of all the measurements that 
could be secured. The work was very comprehensive in 
scope and the main results have not yet been given to the 
public, but a partial result has been seen in the graphic 
chart that was prepared in 1886 (see appendix I.) by which 
Dr. Sargent was able to give a person an idea of how he 
compared with the whole body of students whose measures 
had been tabulated. A second result was seen in the July 
and October numbers of " Scribner's Magazine" for 1887, 
where, in an article on "The Physical Characteristics of the 
Athlete," certain well-known men were pictured graphically 
as well as literally, and thus the application of the method 
was more clearly impressed by Dr. Sargent on the minds 
of persons engaged in physical education. 

Meanwhile Dr. Hitchcock of Amherst College, who had 
published tables of average measurements of Amherst stu- 
dents of all ages, from fifteen up to twenty-eight years, and 
tables of averages where height instead of age was the basis 
of tabulation, issued a table in which the latter averages 
were arranged on a sheet in order from shortest to tallest, 
by gradation of one centimeter, and the records of an or- 
dinary person, could be indicated on this new table in a 
graphic way. In 1887 an ''adjusted averages" table was 



1 2/1. Graphic Anthropometry. 

prepared as a simple acknowledgment that the tables were 
compiled from so few records in many cases that there was 
considerable irregularity, and therefore after determining 
the apparent law of variation, the table was made to con- 
form more or less closely to this law, and a better sheet 
for graphic illustration was produced. The numerical com- 
parison method that has been in use at Amherst for over 
twenty-five years is still the favorite one there. See page 
126. The tables compiled by Dr. Hitchcock are the most 
complete in existence in this country, the records all having 
been taken by one man. 

In 1888 the measurements of Yale students for five years, 
that had been taken by the author and that included every 
man in the undergraduate departments for three years and 
of two other academical classes, except three men, for four 
years ; altogether over 2,200 men were compiled and ar- 
ranged in tabular form according to the method of Mr. 
Galton. See appendix II. 

This has furnished a table for graphic illustration and 
personal information that is fairly complete. It combines 
the comparison of a man's record with the whole mass of 
students ; a comparison with the mean ; the statement of 
the actual numerical size of each part of an individual, and 
its relation to every other part. 

Dr. Fremont Swain of Brooklyn also, in 1888, devised a 
chart for graphic illustration, using the figures of Dr. Sar- 
gent as a basis. 

In 1889 Dr. W. L. Savage of Savage's Gymnastic Institute, 
308 West 59th Street, New York City, devised a chart for 
use in plotting the measures of boys and youths. See ap- 
pendix III. The scheme is very ingenious and will be found 
generally useful when the table on which it is based is placed 
in the hands of instructors. The chart can be used for any 
age and gives absolute record of averages rather than com- 
parative. For boys the method of averages is probably the 
best, as the method of means can not be scientifically used 
in compiling data derived from all ages as is being done 
at present by some prominent teachers and anthropome- 
trists, the material not being homogeneous. 



Graphic Anthropometry. 12^ 

In the present year undoubtedly the most completely 
graphic method that has yet been devised was completed 
by Dr. E. Hitchcock, Jr., of Cornell University. See appen- 
dix IV. It is based on the tabulation of 15,000 sets of 
measurements — all made by physicians who are experi- 
enced in the work. The figure is drawn from the average of 
the various measures, and lines to right and left show in a 
perfect manner the relation of girths as they are actually 
found to exist. The relation in size of limb girths to semi- 
girths of the trunk have never been so clearly demonstrated 
before, and therefore the chart is an important contribution 
to artistic anatomy. This chart has been the product of a 
larger compilation of measurements than has ever before 
been made of the same class in the community. 

" The Table first following, which is called the Average 
Anthropometric Table, exhibits, under fifty-five items, the 
average measurements of bodily proportions and tests of 
strength which were obtained during the college years 
1 86 1-2 to 1888-9 from the study of nearly eight thousand 
Amherst College students seventeen to twenty-six years of 
age. 

The Table is so arranged that it may be used to record 
the measurements of any young man, affording him a ready 
comparison of himself with the normal or average young 
man as represented by the printed columns of figures. 

To record the results of an examination : if the item is 
less than the standard as represented in these central col- 
umns, put it in the left blank space ; if the same or greater, 
put it in the right. In this way, when the examination is 
fully recorded, the person can ascertain at a glance, by 
simple addition or subtraction, how much he varies from the 
measurements of a young man of 1725 millimetres, or 67.9 
inches stature, which is regarded as the standard for the 
students of Amherst College. Should he desire to know 
the percentage of difference between himself and the stan- 
dard, a simple division will inform him, and its result, 
whether less or greater, can be recorded on the outer blank 
space." 



126 



Graphic Anthropometry. 



AVERAGE ANTHROPOMETRIC TABLE. 

7725 millimeters, or 6y.g inches being the standard. 





Items. 


Per 
Cent. 


Below 
Aver- 
age. 


Metric English 
System. System. 


At or 

above 

A verage. 


Per 
Cent. 














We 








Kilos. Pounds. 
61.2 134.6 
















Sta 








M. M. Inches. 

1725 67.9 
















5 

$- 


[ Sternum, . . 






1410 S5-£ 
1030 40.6 
860 33.9 
903 35-5 
475 18.7 






Navel, 










Pubes, 










Sitting, 










1 Knee, 










. . 














Head, 






572 22.5 
349 13-8 
880 34.6 
927 36.5 
724 28.4 
893 35-1 
517 20.3 
512 20.2 
361 14-3 
359 14-2 
359 14-2 
349 13-8 
245 9-5 
242 9.4 
257 lO.O 

253 9-9 
295 II. 6 
251 9-8 
247 9-7 
267 10.5 
261 10.2 
166 6.5 
16s 6.5 








Neck, 












Chest, repose, 












Chest, full, 












Belly, 












Hips, 












Right Thigh, 






1 .^ 




Left Thigh, 












Right Knee, 












Left Knee, 










1^ 

OS 


Right Calf, 










Left Calf, 










Right Instep, 










Left Instep, 












R. U. Arm, 












L. U. Arm, 












R. U. A., cent., 













Right Elbow, 












Left Elbow, 












Right Forearm, 












Left Forearm, 












Right Wrist, 












L Left Wrist, 












Head, 






155 6.1 
108 4.2 
430 16.9 
198 7.8 
250 g.8 
323 12.7 






Neck, 










Shoulders, 










Nipples, 










Waist, 










I Hips, 










n 


Chest, 












Abdomen, 


























f R. Shoulder Elbow,.. 






373 H-7 
371 14.6 
461 18.1 
459 18.0 
260 10.2 
259 10.2 
1780 70.1 
1732 68.1 






. 


Left Shoulder Elbow, 
Right Elbow Tip, 




















Left Elbow Tip, 












Right Foot, 










Left Foot, 










i>^ 


Stretch of Arms, 












. Horizontal Length,... 






























Kilos. Pounds. 
1-5 3-3° 
137 301 
166 36s 

41-5 91-3 
38.1 83.8 
No. of times. 
6 

9 






rS> 


Back 










■» 


Legs, 










1 ' 


Right Forearm, 










Left Forearm, . . 












Dip, 










00 








l Pull Up, 




















Luh 








Litres. Cub. In. 
3.77 230 
















PlLOSITV, 






Tenths of Body. 
2.25 







* Depths. 



Graphic Anthropometry. 12'j 

The numerical method of comparison has been the one 
in most general use because the data necessary for making 
a graphic picture of a person's anatomical proportions has 
only recently been made public. The advantage of a graphic 
illustration of physical proportions is as great as the ad- 
vantage of that method in any department of scientific 
work. It discloses at a glance what is discovered only 
after considerable time spent in study of figures. It would 
seem that the union of the graphic and numerical methods 
of stating the proportions of an individual must be more 
comprehensive than either method alone, and more satis- 
factory to both instructor and student. 

The use of photography is a legitimate application of 
graphic principles and it will soon be employed in all gym- 
nasiums where scientific study and accurate work is accom- 
plished. It gives an idea of the form of a man that cannot 
be derived from figures or graphic lines, and will therefore 
show results of exercise that figures can not express. 



u 





E JtBOVC Z 

i 95 00 80 70 60 50 40 30 20 10 5 | 




= BtLow ; 

E 5 10 20 30 40 50 60 70 80 SO 95 s 




j.. ... . . _.| — 




Age T 




WcigM \"V 




HsiRht Slandinir. \ ' •■ 




7 j- 
" Sitting.... ^ ^■- , 




•• Knee "I" , 




" PubitArch "~~~-3^.j.r' 




., sternum.. ■z:r.-'-''"' 




Girth Head . ~ "'""^-ii:- 




■• Neck .----' ^'1 , 




■■ Chest _. -' 




" Full.. _, _ ,. ! 




•' Waist _ _""^--,'i 1 , 1 ' ■ L 




" Hips .«:';;''i' 1 r 




•• Thigh R... '"'S-'^-L. X. 




... .. t.. t T-ft ^ 




•■ Knee R.. , _I II ~" ~E-i ;-- - _ - _L 




'' •• t. :.____.? T_ -___ X 




•• CalfR .-'-:-'-'■" T ' IL 




..... I _ • ' t\ 1 




" rnstep R.. -~~I~~--;s.i. ■_ J X - 




•• .. L.. ^^ . IT It I fT_ 




■• Up Arm R.. -■c---ZZ--''~'~"" ^ ' I 




■• •• L.. .„^.._. :!-..___._.. _. _._.. 1. ....._ 




.• Elbow R... __»_'' _ Jj 




•• •• L..: ....::......:,__„_:..::"':::"""■:":::_:::_._...!._ 




" foro Arm R.. ,-''' J'' ' ' 




" - " L. , , 




•• Wr.stR... ~E~~ri:^~""~ • ■, X -L 




■• •• L,.. r? __:::—- ::::---ti ::_ i.. 




OepthChcst \,.-- '' ' ' 




" Abdomen.. "'*. ;^ ' j i 




Breadth Head.... ^., 4; _ _, J _^. 




•■ Neck N_ , --■ ,1 




•• Shoulders Ch" 1- 




■• Waist.... '"'"'"'^^--c-- r 




H.ps ..'-ZZZZ- ''' -_ -_L __ _ - . 




^ _ .i^_ _ , -_ -_ _._-.- -- .-1- 
Shoulder-tlbow R'. n, ^.^ , 




" " L. .. _ _ ^ T 




Elbow.TIp R "'^^---."j I 




" •• L 




Length Foot R ^^^ ~~~--^ 




' .7 .. . " ;■' / ~ . ----- _p 




" HorContal. -.^s^^"''"" 




Stretch of Arms .. '"~ -^ 




Capacity Lungs... _ i_ .'. ~''"-^..._ . ---.,_„ 




Strength Lunps.. ::;--- 




* " Eac-« ".'--■ 




■■ Legs.... -_-__5__-_r..,_ "■■-'- ..__ _. r_ 




Chest... . _ _£; - _ __ _„=.--m' _ - _ .- 




" Upper Arrris. _ , _, 




" fore Armj.. "^-^ ,'" 1 




Total.... ^--''' ~""---.. 




Development , ^ ^ ' ^ " _, 




Vision 1 




Hcar.rg -j 4- J 4- 1- 




- _ - - I .. . _ _ ■_ . . ,. -__r 



1 and compiled by 

pounds.) 


Jay 


w. 


Seaver, 


M. 


D. 












I 


BKEADTH. 


Depth. 


si 










a 
W 

^4 


i 


6 


1 

1-1 


1 

M 


i 

K 


S 


02 


jj 


1 

a, 
p. 




ft 
E 


1 

6 


J 

< 








































. 404 

15.9 


403 

15-9 


406 

16. 


407 

16. 


260 

10.3 


260 

10.3 


166 

6.5 


131 

4-8 


457 

iS. 


330 

13- 


332 

9.2 


300 

11. 


363 

14.3 


225 

S.o 


225 

3.0 


5.70 

34S 


239 


373 

600 


83 

ISO 


394 

* 15-5 


394 

15.5 


395 

15.6 


397 

15.6 


256 

10. 1 


256 

10. 1 


164 

6-5 


119 448 

4-7 17-7 


333 

12.7 


225 

8.9 


387 
II .3 


355 

14. 


215 

8.S 


2141 
8.4 


5.40 

330 


220 

4S5 


361 

575 


75 

130 


" 385 

"5-2 


385 

15.2 


386 

15.2 


388 


252 

10. 


252 

10. 


162 

6.4 


115 442 

4-5j 17-4 


314 

12.4 


220 

8.7 


281 

II. I 


349 

13.8 


205 

8.1 


204 

8. 


5.16 

315 


211 

465 


247 

545 


70 

120 


" 379 

I14.9 


379 

14.9 


377 

14.8 


377 

14.8 


247 

9-7 


248 

9.7 


161 

6.3 


113 

4-4 


433 

17- 


306 

12. 1 


216 

8.5 


274 

10. S 


344 

13.6 


199 

7.8 


201 

7.9 


4.94 

302 


195 

430 


231 

510 


67 

"5 


- 373 

I14.7 


373 

14-7 


373 373 

14.7 14.7 


243 

9.6 


244 
9.6 


160 

6-3 


112 

4-4 


428 

16.9 


298 

II. 8 


212 

8.3 


270 

10. 6 


340 

13.4 


197 

7.8 


198 

7.8 


4.76 

290 


186 

410 


226 

49 S 


65 

no 


— 368 
2i4-5 


370 

14.6 


368 368 

HS 14-5 


241 

9-5 


343 

9-.S 


159 

6.2 


111 

4-4 


434 

16.7 


293 

II. 5 


208 

8.2 


267 337 

10-5 13.3 


195 

7-7 


194 

7-7 


4.63 

282 


179 

395 


317 

478 


63 

106 


— 365 

214.4 


367 

14-5 


364 

143 


364 

14-3 


239 

0.4 


240 

9-5 


158 

6.2 


111 

4-4 


421 

16.6 


288 

II-3 


205 

8.1 


364 334 

I0.4 13.2 


193 

7.6 


191 

7.5 


4.53 

273 


175 

385 


211 

465 


61 

102 


— 363 

3 14-3 


365 

14.4 


361 

14.2 


361 

14.2 


238 

9-4 


239 

9-4 


157 

6.2 


110 

4-3 


418 

16.5 


283 

II. I 


203 

8. 


263 

10.3 


331 

13 I 


191 

7.5 


188 

7.4 


4.45 

270 


171 

376 


206 

454 


60 

100 


- 360 

Jx4.2 


363 

14-3 


358 

14. 1 


358 

14. 1 


236 

9-3 


237 

9-3 


156 

6,1 


109! 415 

4.3 16.4 


279 

II. 


201 

7.9 


359 

10.2 


339 

13. 


190 

7.5 


186 

7-3 


4.37 

264 


167 

367 


201 

442 


59 

98 


— 358 
<li4.i 


359 

14.2 


355 

14- 


355 

14. 


234 

9.2 


235 
9.2 


156 

6.1 


108 413 

4-3, 16.3 


276 

10. 9 


199 

7-8 


257 

10. 1 


327 

12.9 


189 

1 7-4 


184 

7.3 


4.30 

261 


162 

356 


195 

430 


58 

96 


~ a56 

^14. 


357 

14. 


353 

13-9 


353 

13.8 


233 

9.2 


23tj 
9.2; 


155 

6.1 


107! ^0 

4.2^ l6.2 


273 196 

lo.s: 7.7 


255 

10. 


325 

12.8 


183 

7.4 


183 

7.2 


4.22 


157 

345 


191 

420 


57 

94 


fi4. 


355 

14- 


' 350 

13-8 


350 

I3-S 


331 

9.1 


333! 

5■^ 


155 

6.1 


106 407 270 

4.2 16. 10.7 


194 

7.7 


253 

10. 


333 

12.7 


187 

7.4 


181 

7.1 


4.15 

253 


153 

33S 


186 

410 


56 

92 


~ 353 

-113.9 


353 

13-9 


348 

13-7 


347 

137 


330 

9-1 


331 i 

9.1 


155 

6.1 


f. 


4a5 

16. 


268 
10.6 


193 

7.6 


251 

9.9 


331 

12.7 


186 

7.3 


179 

7- 


4.07 

250 


1.50 

330 


183 

403 


55 

90 


- 350 

^13-8 


351 

13-8 


345 

13-6 


344 

13.6 


339 

9- 


330 

9- 


154 

6.1 


105 

4-2 


403 

IS. 8 


265 

10. 5 


190 

7.5 


249 

9.8 


319 

12.6 


184 

7-3 


178 

7- 


4.00 

244 


145 

320 


179 

395 


53 

88 


- 348 
J ^3.7 


349 

13-7 


343 

13-5 


341 

13-5 


337 
9- 


328 
9- 


153 

6. 


104 

41 


400 

15-8 


263 

10.4 


188 
7-4 


347 

9-7 


317 

12-5 


183 

7.2 


177 

7- 


3.92 

240 


140 

308 


176 

387 


53 

86 


- 346 

J 13.6 


346 

13.6 


339 

13-4 


338 

13-3 


336 

8.9 


337 
9- 


153 

6. 


103 

4.1 


397 

15-7 


361 

10.3 


186 

7.3 


245 

9.7 


315 

12.4 


180 

7.1 


175 

6.9 


3.83 

232 


135 

298 


171 

376 


51 

84 


- 343 

5 13.5 


343 

13-5 


335 

13.2 


335 

13.2 


335 

8.9 


236 

8.9 


152 

6. 


103 

41 


394 

iS-S 


359 

10.2 


184 

7.2 


243 

9.6 


313 

13.3 


178 

7. 


174 

6.9 


3.73 

22S 


130 

2S7 


166 

365 


50 

82 


- 339 

'13-4 


3t0 

13-4 


331 

13- 


331 

13. 


233 

S 8 


224 

8.8 


151 

5-9 


103 

4- 


391 

15.4 


257 

10. 1 


181 

7.1 


240 

9-5 


310 

12.2 


176 

6.9 


172 1 
6.8^ 


3.63 

220 


135 

275 


159 

350 


49 

So 


~ 336 

^X3.3 


337 

13-3 


337 

12.9 


337 

12.9 


221 

8.7 


233 
8.7 


150 

5-9 


101 

4- 


387 
15-3 


354 

10. 


178 

7. 


237 

9.4 


307 

12 I 


173 

6.8 


170| 
6.7 


3.48 

212 


130 

26s 


151 

332 


47 i 

75 1 


' 333 
■I3-I 


334 

13.2 


333 333 

12.7 12.7 


218 

8.6 


3191 

8.6 


149 

5-9 


98 

3-9 


333 

iS-i 


247 

9.8 


175 

6.0 


234 

9.2 


303 

II. 9 


1 170 

6.7 


167 i 

6.6 


3.35 

205 


113 

24S 


144 

317 


45 

70 


- 336 

12.8 


337 

12.9 


316 

12.5 


316 

12. 5 


216 

8.5 


316 

8.5 


147 

5-8 


93 

3-9 


375 

14.3 


240 

9-5 


170 

6.7 


330 

9.1 


297 
II. 7 


167 

6.6 


1631 

6.5 


3.13 

192 


104 

230 


136 

300 


43 

6S 


- 330 

'' 12.6 


333 

12.7 


310 

12.2 


310 

12.2 


213 

8.4 


212 

8.4 


145 

5-7 


96 

3-8 


368 

14-5 


233 

9.2 


164 

6.5 


235 

8.9 


292 

"■5 


164 

6.3 


159 

6.3 


3.90 

178 


95 

2TO 


135 

275 


41 

60 


" 313 

12.3 


315 

12.4 


304 

12 


304 
12. 


208 

8.2 


208 

8.2 


143 

5-6 


94 

3-7 


3S1 

14.2 


338 

9- 


160 

6.3 


220 

8.7 


286 

II -3 


160 

6.3 


152 

6. 


2.65 

162 


84 

185 


114 

250 


as 

55 


' 








































8 . 1- 


COPYRIGHTED 1 

)V 


389, BY J. W. SEAVER. ■ 








J ' 

















ANTHROPOMHTRIC TABLE. 

Arranged according to the percentages indicated at the left, from measurements taken and compiled by Jay W. Seaver, M. D. 

{The black figures represent millimeters and kilograms ; the red, inches and] pounds.) 



e4 

CM 




EH 

2 


HEIGHT. 


LENGTH. 


GIRTH. 


BHEADTH. 


Depth. | 


it 


4 

to 


4 


tl 




1 


a 

3 

S 


1 


1 

3 


to 


1 


■6a 
SS 

m 


la 
CO 

►4 


If 


if 

4 


I 
t 




4 


1 


ii 
!3 


a 
1 

6 


a 

1 




1 






m" 


1 

i4 



H 





a 
1 


1 
4 


1 


i 


.a 


I 
i-i 


1 


1 

M 


i 


1 


^ 


"a 


W 


1 


1 
1 

to 


1 


i 


1 


t 
K 


1 


1 














































































































1 


Zl. 


86.1 

190 


1876 

73.8 


1546 

60.3 


U46 

45 I 


966 

37.6 


986 

33. S 


494 
19.5 


4ia 
16.2 


410 

16. 1 


513 


bi2 


19o0 

76.7 


280 


280 


600 

23.6 


397 

15-7 


1005 

39-5 


1060 

41.8 


857 

3i--7 


1046 


363 

14-3 


315 


310 


272 

10.7 


268 
10.6 


302 

11. 7 


295 

11.6 


183 
7-2 


182 

7-2 


616 

24.3 


614 

24,2 


404 
15.9 


403 

15-9 


406 

16. 


407 

16. 


260 

10.3 


260 

10.3 


166 

6.5 


131 

4-8 


457 

'3. 


330 

13- 


232 

9.2 


300 

11. 8 


363 

14.3 


225 

3-9 


225 

8.9 


5.70 

34? 


229 

5"5 


272 

6to 


82 




2.5 


2.5.5 


81.1 

'7? 


1849 

7'-7 


1524 

fio. 


lias 

44-3 


936 

36.8 


971 

3S.3 


486 
19.1 


404 

15-9 


403 

15.9 


5U5 

19.9 


604 

.9.8 


1920 

75-6 


277 

10.9 


276 


596 

23-5 


386 


970 

38-2, 


1035 

40'.4 


833 

32. 8 


1000 

39.4 


m 


-888 


-293 


263 

10.4 


258 


293 

II. 5 


285 


180 

7-1 


178 

7- 


593 

23-4 


586 

23.1 


394 

15-5 


394 

15-5 


395 

'5.6 


397 

15.6 


256 


256 


164 

6.5 


U9 

4-7 


448 

'7-7 


322 

'2-7 


235 


287 

"•3 


355 


215 

3.5 


214 

8.4 


6.40 


220 

485 


261 


76 




S 


24. 


,77.\ 


1827 

71.9 


1506 

S9-2 


1110 

43-7 


«2o 

36.4 


960 

37. C 


47 7 

10. S 


398 

15.7 


396 

15 6 


497 

.9.6 


497 

19.6 


1894 

74.5 


274 


273 

I0.7 


593 

=3-3 


m 

14.9 


_9^t 

37-4 


1005 

39-5 


810 

31-9 


974 

38.4 


337 


290 


284 


255 


250 

0.3 


288 


280 


176 

6*.9 


175 

6.9 


577 


670 

22.4 


385 

15.2 


385 

15.2 


386 

15.2 


388 

'5.3 


252 


252 


103 

6.4 


115 

4-5 


443 

17-4 


314 


220 

8.7 


281 


349 


205 

8.1 


204 


6.16 


2U 

4'''5 


247 


70 




10 


22.6^ 


74.4 
164 


1805 


1490 

53.6 


1096 
431 


910 

35-S 


952 

37-'. 


472 

1S.6 


393 

15-5 


390 

15-4 


490 

'9-3 


488 

19.2 


1872 

73-7 


270 

10.6 


269 

10.6 


588 

23.2 


373 

14.6 


930 

36.6 


980 

38.6 


790 

31.1 


953 

37-5 


337 

12.9 


282 


275 


249 

9.8 


245 

9-7 


283 


275 

10. 3 


173 

6.8 


172 

6.3 


560 


554 

21.8 


379 

14.9 


379 

14.9 


377 

14.3 


377 

14.8 


247 

9-7 


248 

9-7 


161 

6.3 


113 

4-4 


433 

'7- 


306 


216 

3.5 


274 


344 

,3.6 


199 

7-8 


201 

7-9 


4.94 

30; 


195 


231 


67 

■■5 




15 


21.10 


72.1 

159 


1790 

70.4 


1476 

sS.i 


1084 

42. c 


900 

35-4 


944 

37.2 


467 


388 


386 

15.2 


483 

19. 


483 

ig. 


1854 

73- 


266 

10.5 


266 

10.5 


583 

=3- 


868 

14-5 


915 

3«. 


966 

3S. 


779 
30.7 


943 

37-1 


331 

J2.6 


276 
10.9 


270 
10.7 


245 

9-7 


241 

9-5 


278 


271 

10.7 


171 

6.7 


170 

6.7 


651 

21.7 


544 
21.4 


373 

14-7 


373 

'4-7 


372 

14-7 


373 

14.7 


243 

0.6 


244 

9-6 


160 

6.3 


113 


428 

16.9 


298 

11. s 


212 

8.3 


270 


340 

13.4 


197 

7.8 


198 

7-S 


4.76 


186 


226 


65 




20 


21.4 


69.4 

'53 


1775 

69. s 


1464 

57.6 


1074 


691 

35.1 


938 

36.9 


463 


084 


382 

'5- 


480 

1S.9 


479 

13.9 


1840 

72.4 


264 

10.4 


264 


580 


365 

14.4 


905 

35.6 


955 

37.6 


769 

30-3 


934 

36.3 


315 

12.4 


273 
10.7 


266 

10.5 


242 

9-5 


233 

9-4 


275 

10.9 


268 
10.5 


170 

6.7 


169 

6.7 


544 

21.4 


538 


868 

14-5 


370 

.4.6 


368 

14.5 


368 

14.5 


241 

9.5 


242 


159 

6,2 


111 


424 

16.7 


293 

II. 5 


208 


267 


337 

13-3 


195 


194 

7-7, 


4.63 


179 


S17 


63 

106 




25 


20.11 


68.0 

151 


1765 

69.5 


1452 

57 ■ 


1065 

41.9 


884 

34-7 


933 

36.7 


459 

iS.i 


381 


378 

14.9 


47V 

1S.8 


476 

1S.7 


1826 


262 

10,3 


262 

10 -3 


578 


363 

14.3 


895 

35-3 


946 

37-3 


761 

30- 


924 

36-4 


311 

12.3 


268 
10.6 


262 
10.3 


239 

9-4 


235 

9-3 


272 
10.7 


265 

10.4 


169 

6.6 


168 

6.6 


538 


632 


366 

14.4 


367 

14.5 


364 

•4 3 


364 

14.3 


239 


240 

9-5 


168 

6.2 


lU 

4-4 


421 


288 

11.3 


206 

3.1 


264 


334 

13-2 


193 

7.6 


191 


4.63 

= 73 


175 


311 


61 




30 


20.7 


67.6 

149 


1754 

69 


1443 

56.7 


1057 

41.6 


877 

34-5 


927 

36.3 


456 

18, 


378 

14.9 


376 

■ 4.3 


474 

i3.7 


473 

i3.6 


1814 

71.3 


260 

10.3 


260 


575 

22.0 


360 

14 2 


888 


938 

36.9 


754 

29. V 


918 

.36.1 


308 


265 

JO. 5 


259 


237 

9-3 


232 

9 2 


270 
10.6 


263 
10.3 


168 

6.6 


167 

6 5 


534 


537 

20.7 


363 

14-3 


365 

'4-4 


361 

14.2 


361 

14.2 


238 


239 

9-4 


157 


ilO 


418 


283 


203 

8. 


262 

10.3 


331 

'3 ' 


191 

7-5 


188 

7-4 


4.45 

270 


171 

37I' 


206 

454 


60 




35 


20.3 


65.8 

14s 


1746 

68 7 


1435 

56-5 


1051 

41-4 


871 

34 ■ 3 


922 

36-3 


453 


37s 

.4.3 


373 

147 


471 


470 

13.5 


1804 

71- 


259 


259 


573 


357 

14 I 


881 

34-7 


930 

36.6 


747 


9ia 

35-9 


304 


263 


256 


235 

9-3 


230 
91 


268 
10 5 


261 

10.3 


167 
6.5 


166 

6.5 


529 

20.8 


623 

20.6 


360 
14.2 


363 

'4-3 


358 
14.1 


358 


236 

9-J 


237 


1.56 


109 


416 


2'/9 


201 

7-9 


269 


329 

'3 


190 

7-5 


186 1 

7-3 


4.37 

=64 


167 

367 


201 

442 


59 

98 




40 


20. 


64.9 

141 


1737 

63. 4 


1427 

56.2 


1045 


866 

34.1 


917 

36.1 


4.50 


373 


372 

14.6 


468 

l8.4 


467 

18. .| 


1795 

70.7 


258 


257 


671 


354 

14. 


875 

34-5 


923 

3S.3 


741 

29.2 


900 

35-7 


301 

II. 9 


259 

10.3 


253 


233 

9.2 


238 
9- 


265 


259 


166 

6.5 


165 

6-5 


534 


519 


358 

14.1 


359 

14.2 


355 

14. 


355 

14. 


334 

9.2 


235 

0.2 


156 

6.1 


108 

4-3 


413 

'6.3 


276 


199 

7-3 


257 


337 


189 

7-4 


184 


4.30 


162 

35" 


19o 

43° 


58 
96 




45 


19.9 


63.5 

J40 


1730 

63. 1 


1420 

55-9 


1039 

40.9 


860 

33. s 


913 

35 9 


448 

"7-7 


370 

14.6 


360 

>4-£ 


464 


463 

l3.2 


1786 

70.2 


256 


255 


569 

22.4 


352 

13.9 


868 

34-1 


916 

36.1 


735 

29. 


900 

35-4 


298 

II. 7 


356 


250 

9.9 


231 

9-1 


226 

89 


263 


356 


165 

<5-5 


164 

6.4 


519 

20.4 


514 

20.3 


356 

14- 


357 
14. 


a52 

'3-9 


352 

13.8 


233 

9.2 


234 

9-2 


155 

6.1 


107 

4-2 


410 

l6.2 


273 

10.8 


196 

7.7 


25:5 


335 

12.8 


188 

7-4 


183 

7- = 


4.22 


1.57 

345 


191 

420 


57 

_2i 




50 


10.7 


63.1 


1724 

I7.8 


1415 

55-7 


1033 

40.6 


33,6 


910 

15 - f 


446 

17.61 


368 

14-5 


368 

14.4 


462 

l3.2 


461 

18.2 


1778 

70. 


254 


254 


568 


350 

13. 3 


831 
33-9 


910 

35-8 


730 

28.7 


896 

35-3 


205 

II. 6 


254 


248 

9.S 


339 

9- 


224 

8.3 


261 


254 


-164 

6-4 


163 

6.4 


515 

20.3 


509 


354 

14- 


355 

'4- 


350 

13.3 


350 

13-S 


231 

9.1 


333 


155 


106 

4-2 


407 


270 

10.7 


194 

7.7 


253 


333 

12.7 


187 
7 4 


181 


4,15 


"l.wl 


186 


66 

92 




45 


19.6 


61.7 

.36 


1717 

07-5 


1410 

55 5 


1037 

40.4 


850 

33-5 


907 

35-7 


44-t 

17.5 


366 

14.4 


364 

14-3 


460 

i3.i 


459 

18.1 


1768 

69,6 


25a 


253 

9-9 


567 

22.3 


348 

13-7 


854 

33-6 


904 

35.6 


735 
28.5 


891 

35- 


293 

II. 5 


251 

9-9 


246 

9-7 


227 

9- 


333 

8-7 


259 


253 

9-9 


163 

6-4 


162 

6.4 


511 


505 
19.8 


352 

13-9 


353 

'3-9 


348 

13-7 


347 

'3-7 


230 

9-' 


231 

9.1 


155 

6.1 


105 

4.2 


40.5 

'6. 


268 
10.6 


l'J3 

7.6 


251 

9.9 


321 

12.7 


186 

7-3 


179 

7- 


4.07 


l.iU 


183 


55 

90 




40 


19.4 


60.8 

134 


1710 

67.3 


1403 

55 = 


1023 

40.2 


844 


903 

35 -f' 


442 

17.4 


364 

14-3 


362 

14-3 


457 

18. 


456 

18 


1759 

69.2 


9-9 


251 

9.9 


665 


346 

13-6 


848 

33-4 


898 

35-4 


719 

23.3 


885 

34-8 


288 

II. 4 


248 
9-7 


242 
9-5 


235 

8.9 


220 

8.6 


257 


260 

9.8 


162 

6.4 


161 

6.3 


■M 
10.9 


501 

19.7 


360 
13. s 


351 

.3-8 


34o 

'3-6 


344 

13-6 


229 
9- 


230 

9- 


lo4 

6.1 


lOo 

4-2 


402 
'5-8 


266 

'0-5 


190 

7-5 


249 

9.3 


319 

12.6 


184 

7-3 


IV 8 


4.00 

244 


14i) 

320 


IV 9] 

395 


88 




35 


19.1 


59.4 


1703 

«7- 


1396 

55 


1017 

40- 


840 


899 

35-4 


439 

17.3 


361 

14.2 


359 

14.2 


455 

17.9 


454 

17.9 


1749 

68.8 


250 

9.9 


250 

9.8 


584 


343 

13-5 


842 

33-1 


892 


713 

23.1 


880 

34.6 


285 


245 

9-7 


240 

9-5 


8.7 


218 

8.6 


255 


i}48 

9-8 


161 

6.3 


160 

6.3 


503 

19. s 


497 

.9.6 


348 

13-7 


349 

'3-7 


342 

13.5 


341 

13-5 


227 
9- 


238 


163 

6. 


104 

4' 


400 

15-8 


263 

10.4 


188 

7-4 


24V 

9-7 


31V 

12 5 


182 

7.2 


IVV 


3.92 


140 

308 


1V6 

387 


86 




30 


18.10 


58.5 


1095 

66.7 


1388 

54 6 


1010 

39-7 


835 

32-9 


805 

35-2 


436 

17. 2 


359 

14.1 


357 


453 

17.8 


451 

17.8 


1739 

68.4 


249 

9.8 


248 

9.8 


562 


341 

13-4 


830 


884 
34.8 


707 

27. 8 


874 
34-4 


283 


243 

9-5 


237 

9-4 


320 

8.6 


216 

8.5 


253 


246 

9-7 


160 

6.3 


159 

6-3 


498 

19.1 


493 

19.4 


345 

13-6 


346 

13.6 


339 
13-4 


338 

13-3 


236 

8.9 


!Si7 
9- 


153 

6. 


103 

4-1 


39V 

15-7 


261 


486 

7-3 


246 

9-7 


316 


7-' 


6.9 


232 


298 


376 


84 




25 


18.6 


57.6 


1687 

66.4 


1380 

54-3 


1004 

39-5 


839 

32.6 


890 

35- 


433 

■7. 


357 


355 

14- 


449 

17-7 


447 

17.6 


1729 

63. 


247 

9-7 


246 

9-7 


560 


339 

13-3 


838 

.32.6 


877 
34-5 


701 

27.6 


867 
34- 1 


278 


239 

9-4 


234 

9.2 


218 

3.6 


214 

8-4 


251 

9.9 


244 

9.6 


159 

6.3 


158 

6.2 


492 
19.4 


485 
19. 1 


342 

13-5 


343 

13-5 


335 

'3-2 


335 

13.2 


225 

8.9 


236 

8-9 


162 

6. 


103 
4 ' 


394 

'5-5 


259 


184 
7.2 


243 

9-6 


313 

13-3 


1V8 
7- 


174 

6.9 


3.V3 


130 

_3S7 


16b 

365 


50 

82 




20 


18.3 


57. 

1 = 5 


1676 

65.9 


1371 


997 

,39-2 


823 

32.4 


884 

34-S 


430 

16.9 


354 

13.9 


a-)2 

13.9 


446 

.7.6 


444 

17.5 


1715 

67.5 


246 

9-7 


244 

9-6 


!a8 

21.9 


337 

13.3 


819 

32.3 


868 

34-2 


695 

27.4 


860 

33-9 


273 

10.7 


236 

9-3 


331 

9.1 


215 

8.5 


211 

8.3 


249 

9.3 


2(3 

9-5 


168 

6.2 


16/ 

6.2 


486 

19.2 


18.9 


13.4 


'3-4 


'3- 


13- 


8 8 


3.8 


5-9 


4- 


'5-4 


..01 


7-' 


9.5 




6.9 


6.8 




27,i 


350 


So 




15 


18. 


55.4 


1664 

65. s 


1300 

53-5 


986 

38. 3 


815 

32.1 


876 

34-5 


436 

16. s 


aw 

13.8 


348 

13.7 


443 

17-4 


442 

17-4 


1700 

66.9 


244 

9-6 


2-43 

9.S 


555 

21.8 


333 

13. 1 


810 

31.9 


858 

33.7 


686 

27 


853 

33-5 


268 
10.6 


233 

9.1 


227 
9- 


312 

8.4 


208 

8.2 


246 

9,6 


339 

9.4 


156 

6.1 


156 

6.1 


480 

1S.9 


475 

18.7 


336 

'3-3 


337 

■3-3 


327 

12.9 


327 
12.9 


221 

8.7 


222 

8.7 


150 

5-9 


101 


;48V 

'5-3 


2i)4 


178 

7- 


237 

9-4 


307 


6 8 


6.7 




265 


332 


75 




10 


17.8 


53.5 

ii3 


1645 

64.7 


1345 

52.9 


974 

38.4 


80S 


868 


433 

16.6 


346 


344 

I, .6 


437 

17.2 


437 

17.2 


1687 

66.3 


240 

9-5 


340 

9.'- 


550 

21.6 


339 

13. 


800 

31-5 


846 

33.3 


677 

26.7 


841 

33-1 


262 

10.3 


227 


222 

3.8 


208 

8.2 


204 

8. 


242 

9-5 


235 

9-3 


155 


154 

6.. 


474 

18.7 


466 

18.3 


333 

13. 1 


334 

13.2 


323 

12.7 


323 

12.7 


218 

8.6 


219 

8.D 


149 

5-9 


98 


382 


247 

98 


176 

6.C 


234 

9.2 


302 


iVO 

6,7 


16V 


3.36 


248 








5 


17.3 


61.3 


1626 


1325 


958 


794 


854 


418 


340 


338 


431 


431 


1658 

fir -> 


236 


235 


545 


aj4 


784 


826 


601 


838 

37 6 


255 


233 

R 8 


217 

R 6 


203 

R 


200 

7.8 


237 


230 


152 

6. 


151 

6. 


463 

iS 2 


455 


336 

12.8 


327 


316 


316 


216 

8.5 


216 

8.5 


147 

5-3 


98 

3-9 


3Vo 

14. 8 


240 

9-5 


170 

6.7 


230 

9.1 


39V 
11.7 


1 16V 

6.6 


163 

6.5 


3.13 


23" 




65 




2.5 


17.1 


49.4 

lO'J 


1605 

63,: 


1314 

5". 7 


947 


780 

30.7 


842 


414 

t6,3 


334 


333 


435 

16.7 


435 

16.7 


1630 

64.1 


333 

9.1 


233 

9.1 


540 

21.3 


318 

12-5 


766 

30. J 


812 

3=- 


W4 

25-4 


814 

32. 


"247 
9.7 


217 

8.6 


213 

8.4 


198 

7-7 


195 

7-7 


232 


225 

8-9 


150 

5-9 


149 

5-9 


450 

'7-7 


444 

17-5 


320 


32:3 

12.7 


310 


310 


213 

8.4 


213 

8.4 


145 

5-7 


96 

3-8 


368 

'4-5 


233 

g.2 


164 

6.5 


225 

8.9 


293 

"■5 


164 

6.5 


159 

6.3 


3.90 

178 


95 


J2o 


a 

60 




1 


lli.7 


45.4 


1576 


1290 

50 8 


931 

36.2 


765 

30 I 


820 


403 


328 


327 

12.9 


418 

16.5 


418 

16.5 


1600 

63. 


226 

8.9 


220 

8.Q 


535 


311 


740 

29.1 


787 

3'- 


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